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LIBRARY OF CONGRESS. 



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UNITED STATES OF AMERICA. 






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DERMATITIS VENENATA: 



AN ACCOUNT 



OF 



THE ACTION OF EXTERNAL IRRITANTS UPON 

THE SKIN. 



BY 

JAMES C. WHITE, M.D., 

\\ 

PBOFESSOB OF DEBMATOLOGY, HAEVAED UNIVERSITY; PHYSICIAN TO OUT-PATIENT DEPARTMENT 

FOB SEIN DISEASES, MASSACHUSETTS GENEBAL HOSPITAL. 



■ ^1 




BOSTON: 

CUPPLES AND HURD, 

Jfletucal Ptxbltsfjets. 

188T. 









Copyright, 1887, y 

By James C. White. 



2Etttberstts $ress: 

John Wilson and Son, Cambridge. 

A 



PREFACE. 



It has been my object in this brief treatise to offer 
to the practitioner some reliable information concern- 
ing all kinds of irritants of the skin, which has not 
been hitherto accessible to him in a collected form. 
I am aware that much of the matter it contains is 
presented in an unsatisfactory manner, because our 
acquaintance with the subject is at present so in- 
complete ; but it is only by recording the little we 
do know that we may hope to add to our definite 
knowledge respecting it. 

I desire to express here my obligation to the follow- 
ing gentlemen for valuable information afforded me 
in reply to my inquiries in their respective fields of 
learning : Asa Gray, M. D., LL. D., Fisher Professor 
of Natural History, Harvard University ; Alexander 
Agassiz, LL.D., Curator of the Museum of Compara- 
tive Zoology, Cambridge ; Prof. Edward S. Morse, 
Director of the Peabody Institute, Salem ; Samuel H. 
Scudder, Esq., Cambridge ; George L. Good ale, M.D., 
Professor of Botany, Harvard University ; William 
H. Geddings, M. D., Aiken, S. C. ; C. G. Lloyd, Esq., 
Cincinnati ; and Prof. F. Peyre Porcher, Charles- 
ton, S. C. 

Boston, April 1, 1887. 



CONTENTS. 



PAGE 

Preface 3 

Pathology of Dermatitis Venenata 9 

Plants 25 

List of Families . 29 

Native and Foreign Plants * . . . 31 

Other Irritants, Organic and Inorganic .... 145 

Animal Irritants 181 

Bibliographical Eeferences 205 

Index 209 



DEKMATITIS VENENATA. 



DERMATITIS VENENATA. 



This title has been generally accepted by derma- 
tologists as meaning those forms of inflammation of 
the skin which are produced by the direct action 
of irritating agencies externally applied. The nature 
of these agents is various, and their number is very 
large. They belong to the vegetable, the animal, and 
the mineral worlds, and to other classes of matter not 
so easily defined. 

Their action upon the skin is sometimes the result 
of design : that is, they may be used by the person 
affected for purposes of deception or malingering, or to 
produce certain beneficial effects ; or they may be em- 
ployed upon another with mischievous intent. They 
are very frequently produced by medicinal applica- 
tions improperly recommended by the physician, or 
improperly employed by the patient. More frequently 
they are caused by quack or domestic remedies applied 
to the skin. They are often the result of contact with 
irritating substances which are used in many of the 
arts and professions ; they are of common occurrence, 
therefore, among dyers, printers, chemists and drug- 
gists, collectors of medicinal plants, silk weavers, 
manufacturers of colored papers and cloths, soap- 



10 DERMATITIS VENENATA. 

makers, etc. They are caused by the use of improper 
cosmetics and by clothing colored by poisonous dyes, 
and by the attacks of certain insects and other ani- 
mals. Most frequently they are produced by plants 
possessing irritating properties. 

The effect produced by these various agents is to 
excite an inflammatory process in the cutaneous tis- 
sues, of all possible degrees of intensity. Under the 
impression produced upon them by the irritant, either 
by insertion within them, by surface contact, or in 
some cases by the influence of emanations alone, the 
capillaries immediately surrounding such point of 
contact enlarge, and produce a visible hyperemia, 
thus establishing a local erythema. This, the first 
stage of the inflammatory process, may affect only a 
minute area, forming a small red point, a macule, or 
extend over a considerable area, and present a uniform 
and extensive field of redness. It may be fugitive, 
lasting but a few minutes, or continue for hours or 
days, and finally disappear without the production of 
any other apparent tissue change. But an erythema 
cannot exist for any considerable time without a slow- 
ing of the current of circulation in the enlarged capil- 
laries, and the consequent escape through them of 
some of the elements of the blood. The serum trans- 
udes and permeates the interspaces between the fibrous 
bundles of the corium, and, pressed upwards through 
the papillary layer, distends and forces apart the cells 
of the rete. This results necessarily in an increase in 
the bulk of their tissues, or, in other words, a swelling 
is produced, This serous transudation is called oedema, 
and this condition is in some degree inseparable from 
an erythema of more than evanescent duration. Red- 



DERMATITIS VENENATA. 11 

ness and swelling, then, are the earliest phenomena of 
dermatitis. 

Sometimes these changes are limited to very cir- 
cumscribed areas. Under peculiar forms of irritation 
an erythema is rapidly excited, which is followed by a 
sudden oedema, so violent as to distend such portions of 
the skin in the form of abrupt elevations with sharply 
denned borders, and to compress in turn the capillaries 
of such areas so as to occlude them, and thus produce 
lesions characterized by flat, strikingly white promi- 
nences, which are generally surrounded by a halo of 
erythema. These lesions are called wheals. They 
may exist for but a few minutes, or for one or more 
hours, but they are always of brief duration. The 
capillaries in the stage of involution begin to absorb 
the effused serum, the swelling sinks down, the red- 
ness returns to the area, and finally the hypersemia 
disappears. The whole process is one of the most sud- 
den and striking exhibitions of morbid action to which 
the skin is liable. It is a frequent phenomenon in 
dermatitis venenata. 

But in addition to the escape of serum consequent 
upon a hypersemic state of the skin, when prolonged 
beyond a brief duration other changes ensue ; the cell 
elements of the blood escape through the vessels and 
add to the previous swelling or oedema. They are 
deposited in the upper layers of the corium about the 
superior capillary plexus in vast numbers, so as to give 
the papillary layer the appearance by the microscope 
of a cell structure. Owing to their presence the skin 
offers a firmer resistance to pressure than that caused 
by the simple oedema, and presents in time a decided 
thickening. This change may affect considerable areas 



12 DERMATITIS VENENATA. 

uniformly, producing a general thickening and eleva- 
tion of the part affected, or it may concentrate itself 
within the papillae especially, the exudation from their 
vascular loops causing them to enlarge either singly 
or in groups, and forcing them, with their epidermal 
coverings, above the general surface of the integument 
in the form of sharply pointed or hemispherical ele- 
vations, red in color, and varying in size from a pin's 
head to a small pea. This form of efflorescence is 
called a papule. It may last a few days, or much 
longer, and slowly sink down, as the effused elements, 
serum and blood cells, are reabsorbed by the vessels, 
and leave no later sign of its existence, or at most a 
slight scale, the result of the changes in its epithelial 
covering, due either to the stretching or devitalization 
of the cells through inflammation. On the other hand 
the epithelial covering of the tip of the softened tis- 
sues may be easily removed by violence, and thus the 
elongated papillae be exposed, allowing the contents 
of the papule to escape, or the enlarged capillaries 
may themselves be ruptured ; in either case, an ex- 
coriation and crust are formed upon its summit, 
thus complicating the process of involution. 

If the tip of such an inflammatory papule be care- 
fully pricked with a needle, so as not to open one of 
its blood-vessels, a minute quantity of clear serum or 
lymph will exude, showing the abundant presence 
of fluid in it. Under the continuance or greater in- 
tensity of the inflammatory process this is poured 
out with such force, or in such quantity, as to tear 
apart the soft plastic cells in the lower layers of the 
rete, and thus form chambers rilled with clear fluid, 
which are traversed by upright columns or threads, 



DERMATITIS VENENATA. 13 

composed of the elongated epithelial cells. Such col- 
lections of serum are called vesicles, or blisters. Their 
roofs consist of the hard and flattened cells of the 
horny layer, which resists the pressure from below of 
the escaping fluids, and appear as a translucent cover- 
ing, through which the nature of their contents may 
be recognized. If the vesicles exceed a certain size 
they are called bullce, or blebs. Their fluid contents 
may after a few hours or days, with a diminution of 
the cutaneous excitement, be gradually reabsorbed, and 
the roof sink down, forming a thick scale, which after 
a short time falls off, leaving the skin still red for a 
while ; this redness in turn disappears, and leaves 
no permanent mark. But vesicles are not always 
thus formed by a transformation of preceding papules. 
They may arise suddenly upon a previously healthy 
area, or follow quickly upon a slightly erythematous 
macule of the briefest duration. If their roofs are 
broken by violence, or ruptured by the fluids exuding 
beneath, their fluid contents escape freely upon the 
surface and form crusts, beneath the protection of 
which the process of repair goes on, with the forma- 
tion of new epithelial cells. 

But vesicles are not the highest stage in this pro- 
gressive formation of surface lesions in dermatitis. 
If it advance, their clear fluid contents are invaded by 
multitudes of migrating round cells pushing up from 
the corium below, so that they appear no longer trans- 
parent beneath their epidermal coverings, but milky 
or turbid ; in other words, they have been transformed 
into pustules. These also may disappear by the ab- 
sorption of their contents, or, if they be ruptured, the 
process of involution will complete itself beneath a 



14 DERMATITIS VENENATA. 

crust or scab. Pustules, however, may form as such 
without a preceding vesicular stage. These are gen- 
erally deeper seated than the superficial forms of in- 
flammation thus far considered, and are often seated 
primarily about the glandular structures, or even in 
the subcutaneous tissues. Larger and deeper forms 
of the pustular or suppurative inflammation are repre- 
sented by lesions called furuncular and ecthymatous. 

Such are the so-called primary lesions of acute der- 
matitis. They may be only progressive steps of the 
inflammatory process, marked by certain well-defined 
stages, — the hyperaemic macule, papule, vesicle, and 
pustule ; or any one of them may arise independently 
as such, and disappear without undergoing further 
evolutionary change. Several or all of them may be 
present at the same time, or any one of them may 
represent the whole process in any case. 

The secondary lesions which occur in dermatitis are 
the changes in the primary forms of eruption, either 
incidental to the decline of the inflammatory process, 
or the result of accidental interference with their nat- 
ural course. The simple erythematous stage may dis- 
appear without the formation of any ; but if intense, 
or of long duration, the overlying epithelium becomes 
modified in its condition so as to form a scale. The 
scale results, too, directly from the natural subsidence 
of the papule or vesicle, and as the final stage or rem- 
nant of nearly all forms of inflammatory eruption, the 
epithelial layers being the last tissue to show indica- 
tions of the retreating disturbance in the skin. 

The excoriation is produced by the removal of the 
cuticle from any of these forms of inflammatory lesion, 
or from the normal integument. It is followed by the 



DERMATITIS VENENATA. 15 

immediate exudation of serum or lymph, or, if the ves- 
sels of the papillae be wounded, by hemorrhage, and the 
subsequent formation of crusts by their coagulation. 
Large areas of inflamed corium may be thus denuded, 
and present surfaces oozing with these fluids, or pus, 
for considerable periods, or they may be laid bare by 
the intensity of the inflammation itself, the epithelial 
layers being washed away and prevented from reform- 
ing until this has subsided. 

Over all such excoriated surfaces, however produced, 
a crust, or scab, must form sooner or later by the co- 
agulation of serum, pus, or blood, according to the 
nature of the primary lesion, varying in appearance 
and consistence according to its composition, to be de- 
tached possibly and formed again, and beneath which 
the new epidermis will eventually form when the con- 
ditions for repair become favorable. 

Should the papillary layer as well as the epidermis 
be removed by violence or the destructive intensity of 
the inflammatory process, we shall have formed a sup- 
purating and granulating surface, a possible ulcer, over 
which also a crust may form, but over which can 
no longer be created a normal cuticle. The fibrous 
structures of the corium may be restored in small or 
excessive measure, but for their final covering only a 
thin layer of modified epithelium is formed. This 
result is the cicatrix. 

These are the lesions, eruptions, efflorescences, as 
they are called, which characterize the changes in the 
cutaneous tissues in dermatitis venenata. Any one 
form may largely predominate in any of its many 
varieties, or most of them may be present, and in their 
successive stages of evolution and involution exhibit a 
great diversity of appearance. 



16 DERMATITIS VENENATA. 

The subjective symptoms which accompany them are 
such as are ordinarily experienced in other inflamma- 
tory affections of the skin in which they occur, but 
somewhat intensified perhaps. They are burning, itch- 
ing, tingling, pain, and sometimes numbness. 

The constitutional disturbances which accompany 
some forms of dermatitis venenata vary greatly in 
character and intensity, sometimes being very severe, 
occasionally proving fatal; but they cannot be con- 
sidered in any general way in this connection. As a 
rule, they are wholly absent. 

The seat of the inflammation is generally those parts 
of the integument most likely to come in contact with 
irritating substances, — those parts which are left un- 
protected by clothing, — the face and hands especially. 
In some of the professional forms of the affection the 
particular craft or trade determines the seat ; in other 
varieties it is selected by will, or depends upon previous 
disturbances in the skin. This is often an important 
element in diagnosis. 

The course of many forms of the affection is most 
acute; indeed, the suddenness of the onset, and the 
rapidity with which so intense an inflammation of the 
cutaneous tissues can pass through so many grades of 
evolution and involution, are one of its most character- 
istic features. Nevertheless, in some cases the process 
is so severe, and penetrates the corium so deeply, that 
its duration must be measured by weeks rather than 
days. It is possible, moreover, that the acute specific 
results of the irritant may pass into ordinary forms of 
dermatoses, which may last indefinitely. Thus chronic 
eczema is a very frequent sequel of many forms of the 
affection. The course may be stated, therefore, as 



DERMATITIS VENENATA. 17 

varying from the evanescent erythema or urticaria of 
a few minutes' stay, to ulcerations which may require 
months to heal, but as a rule it is self -limited. 

Diagnosis. — It would be difficult to state how a 
dermatitis venenata may be distinguished from other 
inflammatory affections which it most closely resem- 
bles, or with which it is in fact identical except in 
its etiology. There are certain distinct types in which 
the skin expresses its disturbances, whether they are 
caused by external irritants, or are the result of in- 
fluences impressed upon it from within itself or other 
parts of the economy, of the nature of which we know 
little or nothing, and this range of expression is very 
limited. Thus a very large proportion of the forms 
of dermatitis produced by individual irritants, which 
we are about to consider in detail, are eczematous in 
character, and can be distinguished from ordinary idi- 
opathic acute eczema only by the most experienced 
eye in many cases. They are in fact eczema ex- 
cited by external agencies. Erythema and urticaria 
are also forms frequently assumed. What difference 
can there be between a wheal produced by the appli- 
cation of the stinging-nettle to the surface of the skin, 
and that caused by the circulation through its tissues 
of irritating substances either introduced through the 
stomach or derived from abnormal conditions of the 
economy? The lesion in one case cannot be distin- 
guished from that in the other. There are certain 
features, however, which the dermatosis artificially 
created presents, by which it may be distinguished in 
the great majority of cases from other forms, whether 
they be identical processes or not. So far as they 
may be described in words, they are mainly a sudden 



18 DERMATITIS VENENATA. 

onset, a rapid evolution of primary lesions, some pecu- 
liarities in their situation within the cutaneous tis- 
sues, an unusual color in their fluid contents, a greater 
intensity of inflammatory action and continuity of de- 
velopment within given areas, the localities attacked 
and the sharply defined limitations of the regions 
affected, a marked asymmetry and an artificial ap- 
pearing configuration in the eruption, their occurrence 
in those employed in certain arts and professions, and 
other unusual, extraordinary appearances at times 
which cannot be defined, — these are some of the most 
striking peculiarities of the affection. Yet the most 
experienced dermatologist will often be unable to de- 
termine in the individual case whether he has one of 
artificial origin before him, even if he suspect it to 
be such, and sometimes, no doubt, treats it without 
even suspecting its true nature. 

Prognosis. — So far as the cutaneous process alone 
is concerned, it is often self-limited, generally brief, 
and always terminates in recovery. Its effects upon 
the general system are seldom serious, but the action 
of the irritant itself upon the economy by absorption 
through the skin is sometimes very powerful, and in 
some cases either immediately or slowly fatal. These 
effects, on the other hand, may appear very threaten- 
ing at first, and quickly disappear. 

Treatment. — The treatment of dermatitis venenata 
differs but little from that required for similar grades 
of cutaneous inflammation in other affections of the 
skin. As the source of irritation is extraneous, how- 
ever, it may generally be removed when recognized, 
and its future action prevented. In a few instances 
antidotes may be usefully employed, in case we are 



DERMATITIS VENENATA. 19 

dealing with alkalies or acids, the chemical antagonists 
of which can be safely and early nsed. Internal reme- 
dies exercise no specific control over any of its forms, 
and are demanded on the general principles of cutane- 
ous therapy only. Neutral alkaline salts and saline 
laxatives are sometimes of benefit in allaying the in- 
tensity of the inflammatory process, and any constitu- 
tional disturbances which occasionally accompany the 
latter should of course receive the attention proper to 
each case. Generally, however, local applications are 
the essential element in treatment. They should be se- 
lected for the direct purpose of soothing and reducing 
the cutaneous inflammation, with reference, of course, 
to the nature of the lesions present in each case. 
Some of the most useful of them may be mentioned. 

Evaporating lotions of warm or cold water, or of 
water and alcohol where the last would not be too 
stimulating, are of service in early hyperaemic stages 
of inflammation, applied constantly or with interrup- 
tions. Should much pruritus accompany, the addition 
of carbolic acid, in the proportion of a drachm to the 
pint of liquid used, will give relief. Weak alkaline 
lotions, solutions of saleratus or carbonate of soda, 
always at hand in the household, may be substituted 
for the above in the first stages, if the irritant be 
an acid. 

If the skin be denuded of its epithelial covering over 
extensive areas, the emollient gelatine preparations 
may be used with advantage, as gelatine 10, glyce- 
rine 40, water 50, melted, and painted with a soft 
brush frequently over the surface. This preparation 
may be medicated in any way, as the cutaneous con- 
dition may suggest. 



20 DERMATITIS VENENATA. 

Washes of many kinds may be used. Black wash is 
one of the most valuable : 

Calomel 3J, lime-water Oj, m., 

applied upon thin cotton or linen cloths as an evapo- 
rating lotion, two or three times daily, for twenty or 
thirty minutes. It should not be employed, however, 
over any extensive surfaces longer than a few days, 
on account of the danger of possible absorption. 

A perfectly harmless and therefore more useful wash 
is the following : 

Zinc oxide 3J, lime-water Oj, m., 

to which may be added carbolic acid 3ss to relieve 
itching, or glycerine §ss upon dry surfaces. This may 
be sopped with a bit of soft rag, freely and at frequent 
intervals, upon all forms of primary lesions, with ad- 
vantage. It is always well borne, and leaves a bland 
protecting powder over denuded surfaces. 

Other washes are : — 

Liq. plumb, subacet. dil. 3viij, glycerine 3ij, m., 
applied upon cloths ; or, — 

Pulv. calaminis ^j, glycerine 3ij, water ^viij, m., 
sopped on freely with a bit of cloth ; or, — 

Sulphate of zinc 3j, water Oj, m. ? may be substi- 
tuted in individual cases with advantage, but I prefer 
the zinc wash in most cases. 

Powders are often of service dusted upon oozing 
surfaces. The best are oxide of zinc or calamine, 
mixed with starch in varying proportions. In the 
crevices of joints and between cutaneous folds they 
sometimes cake, and cause irritation. 

Ointments are generally useful in all but the earliest 



DERMATITIS VENENATA. 21 

stages of the inflammation. They should be made of 
the purest fats ; or cold cream pomade, vaseline, petro- 
latum, may be used as the vehicle. Oxide of zinc 
from ten grains to a drachm, bismuth subnitrate from 
ten grains to a drachm, salicylic acid from five to ten 
grains, or tannic acid five to twenty grains to the 
ounce of any of the above, or diachylon ointment, will 
be found among the best. They may be smeared over 
the surface with the finger very gently, or spread upon 
old cotton or linen cloth and laid over it. They should 
not be stimulating. 

The clothing in contact with affected parts should 
be of soft old cotton or linen, and the patient should 
be cautioned against scratching or rubbing the skin. 

The diet should be simple at first, meat being for- 
bidden, as well as hot drinks, tea and coffee, and alco- 
holic stimulants. 

Generally, by such simple local measures the derma- 
titis will disappear in periods varying from a few days 
to a few weeks, — much more quickly than dermatoses 
of corresponding intensity of idiopathic or unknown 
origin. Should the inflammatory process pass into a 
chronic form, it must be treated by more stimulating 
means, as in cases of ordinary chronic eczema. 



PLANTS. 



PLANTS. 



If one were asked, how many plants are there which 
are poisonous to the skin ? the first answer would very 
likely be, only a very few, — less than half a dozen ; and 
this number would certainly embrace all those which 
come within the physician's ordinary experience as 
capable of producing injurious effects upon the integ- 
ument by external contact. But those with the widest 
knowledge of the affections of the skin, the field bota- 
nist and collector, and those engaged in the pharma- 
ceutical manipulation of our medicinal flora, know 
that this number is only the beginning of a long list 
of plants containing principles poisonous to the skin, 
and capable under certain conditions of producing 
such action upon it. Dermatitis venenata is a very 
wide subject, and in its relations to the vegetable 
world alone much larger than one would imagine 
to be possible who has not especially studied it. 

It may be instructive in the beginning to offer a 
rude attempt at a division or classification of it. It 
would perhaps be impossible to divide the plants 
upon a basis of uniformly and occasionally poisonous, 
because possibly no plant is capable of producing an 
excitement upon the skin of every person ; indeed, the 
few which are most frequently the agents in the pro- 
duction of cases of poisoning are well known to be 



26 DERMATITIS VENENATA. 

entirely powerless over the skins of a large proportion, 
if not the majority, of mankind individually, and the 
reason of the frequent mischief they give rise to is the 
abundant prevalence of their growth in the vicinity 
of man. We may distinguish, — 

1. Those plants which are capable of producing 
injurious effects while growing, either by direct contact 
or near approach. 

2. Those which act only when some part is pur- 
posely applied to the skin. 

3. Those which are active only in a concentrated 
form, or through some principle artificially extracted 
from them. 

The occasion for such action is afforded by accidental, 
unconscious, or unadvised contact with the plants in 
the field; by the necessary handling on the part of 
cultivators and collectors ; by the manipulations in- 
cident to their mercantile and chemical relations ; 
and by their medicinal use. The method of their 
action is, — 

1. By mechanical irritation ; for example, the hairs 
of Mucuna. 

2. By special poison organs, as the stinging glands 
of the Urticae. 

3. By emanations ; the volatile principle in Rhus, 
for illustration. 

4. By contact with so-called acrid or poisonous ele- 
ments contained in various plants. 

The nature of the toxic principle varies. It may 
be in the form of an oil, an acid, an alkaloid, a resin, 
etc. ; but its true chemical character, and the reason 
of its peculiar action upon the cutaneous tissues, are 
in the majority of cases wholly unknown. 



DERMATITIS VENENATA. 27 

The number of native plants, or those introduced 
into the United States, which are capable in some 
degree of injuring the skin, is, as above stated, far 
greater than is generally known. Sixty may be set 
down in this list, to which such action has been at- 
tributed on good authority, and their effect varies from 
the mildest degree of the most fugitive erythema to 
the highest grades of the inflammatory process. No 
distinction can be recognized in point of malignity and 
benignity, whether they be called upon by the physi- 
cian to exert their peculiar action upon man for his 
relief, or make of him an unwilling victim of their 
power ; the simple rubefacient and the most venomous 
poison-plant must both be included in the same list. 

An inquiry into the raison d'etre of such plants, or, 
if we choose to recognize a more independent or a 
more elevated nature in the vegetable kingdom, into 
their motive of action, would be of extreme interest, 
if there were a possible way of conducting it. Al- 
ready we are almost disposed to admit that the car- 
nivorous plants act with consciousness. They spread 
a tempting bait, they make voluntary movements and 
entrap, and they consume their prey and nourish 
themselves therewith. How can the animal do more ? 
We were at first satisfied with a descriptive and ana- 
tomical botany ; within a few years there has grown 
up a science of vegetable physiology ; the psychology 
of plants has yet to be studied. We have been satis- 
fied to regard all living objects as designed solely for 
man's special use, and as under the spell of some blind 
impulse stupidly called instinct, which kept their 
beings in action for that end alone. Lately we have 
been compelled to grant reason and individual inde- 



28 DERMATITIS VENENATA. 

pendence to the animal, as the result of more honest 
and less superstitious observation on our own part. 
Shall we come also to admit a certain degree of intel- 
ligence, of sentient action, in the vegetable world as 
well ? If so, a belief in personal responsibility in 
plant action would necessarily follow. 

It is difficult to see on what selfish grounds the 
poisonous action of most of the plants we are to con- 
sider can be based, which should not apply as well to 
the whole vegetable kingdom. If self-preservation is 
the first law of the plant, why should this peculiar 
means of protection be granted to so few ? Why are 
the tissues and fluids of three species of Rhus amongst 
us, for instance, capable of inflicting an injury upon 
the only being for whom they are supposed to have 
been created, while the other species growing by their 
side, and innumerable genera of other plants around 
them, are harmless to his touch ? They accomplish 
nothing apparently by the exercise of this power 
except to draw upon themselves a more rapid destruc- 
tion. They remind one of certain classes among man- 
kind, which exist, we say, for no good, but because 
animal nature so called is sometimes evil. So we 
may believe that the poison plants are the criminal 
class, because vegetable nature is sometimes evil. The 
existence of the one is as easy or difficult of explana- 
tion under the doctrine of design as the other. 

A list of the plants to which such action has been 
attributed, arranged by families, follows. 



DERMATITIS VENENATA. 



29 



FAMILIES. 



Alismaceae. 

Alisma plantago. 
Anacardiaceae. 

Rhus venenata. 
Rhus toxicodendron. 
Rhus diversiloba. 
Semecarpus anacardium. 

Apocynaceae. 

Neriuin oleander. 

Araceae. 

Arisaema triphyllum. 
Symplocarpus foetidus. 

Araliaceae. 

Aralia spinosa. 

Artocarpaceae. 

Antiaris toxicaria. 

Aurantiaceae. 

Citrus vulgaris. 

Berberidaceae. 

Podophyllum peltatuni. 

Bignoniaceae. 

Catalpa bignonioides. 

Borraginaceae. 

Borago officinalis. 

Cactaceae. 

Cactus grandiflorus. 

Compositae. 

Anacyclus pyrethrum. 
Arnica montana. 
Bidens frondosa. 
Erigeron Canadense. 
Lappa officinalis. 
Leucanthemum vulgare. 
Maruta Cotula. 
Xanthium strumarium. 



Coniferae. 

Abies Canadensis. 

Abies excelsa. 

Juniperus Virginiana. 

Juniperus Sabina. 

Thuja occidentalis. 
Crassulaeeae. 

Seduni acre. 
Cmciferae. 

Lepidium sativum. 

Nasturtium Armoracia. 

Sin apis alba. 

Sinapis nigra. 

Sisymbrium officinale. 
Cucurbitaceae. 

Bryonia alba. 
Droseraceae. 

Drosera rotundifolia. 
Ericaceae. 

Chimaphila umbellata. 

Oxydendrum arboreum. 
Euphorbiaceae. 

Buxus sempervirens. 

Croton tiglium. 

Euphorbia corollata. 

E. ipecac, et al. 

Hura crepitans. 

Hippomane mancinella. 

Jatropha urens. 

Stillingia sylvatica. 
Fungi. 

Ustilago. 
Iridaceae. 

Iris florentina. 
Leguminosae. 

Andira Araroba. 

Mucuna pruriens. 



iriM^jx^ 



A-w^v*-*-* -» f 



30 



DERMATITIS VENENATA. 



Liliacese. 

Allium sativum. 
Asparagus officinalis. 
Urginia scilla. 

Linacese. 

Linum usitatissimum. 

Loasacese. 

Mentzelia oligosperma. 
Mentzelia Lindleyi. 

Lobeliaceae. 

Lobelia inflata. 

Loganiacese. 

Gelsemium sempervirens. 

Melanthaceae. 

Colchicum autumnale. 
Veratrum sabadilla. 

Myrtaceae. 

Eugenia pimenta. 
Myreia acris. 

Orchidacese. 

Cypripedium pubescens. 
Vanilla planifolia. 

PapaveracesB. 

Chelidonium majus. 
Sanguinaria Canadensis. 

Phytolaccacese. 

Phytolacca decandra. 

Piperacese. 

Piper nigrum. 

Polygonacese. 

Polygonum hydropiper. 
Polygonum acre. 

Ranunctilaceae. 

Aconitum napellus. 
Actsea spicata. 



Anemone nemorosa. 
Anemone patens. 
Clematis Virginica. 
Delphinium consolida. 
Delphinium staphisagria. 
Helleborus niger. 
Ranunculus. 

Rubiacese. 

Cephaelis ipecacuanha. 
Cinchona. 

Rutaceae. 

Ailanthus glandulosa. 
Ruta graveolens. 
Pilocarpus pennatifolius. 

Salicacese. 

Populus candicans. 

Scrophtilariaceae. 

Verbascum thapsus. 

Solanaceae. 

Capsicum fastigiatum. 
Datura stramonium. 

Thymeleaceae. 

Daphne mezereum. 
Dirca palustris. 

Tropeolaceae. 

Tropeolum majus. 

Umbelliferae. 

Ferula galbaniflua. 
Heracleum lanatum. 
Thapsia garganica. 

Urticacese. 

Laportea Canadensis. 
Urtica chamsedryoides, di- 
oica, gracilis, purpuras- 
cens, urens. 



DERMATITIS VENENATA. 31 



NATIVE AND FOKEIGN PLANTS. 



ALISMACEM. 

Alisma plantago. Water Plantain. 

This common water plant, which grows abundantly 
in all parts of the country, bears an innocent reputa- 
tion in works on botany ; but the National Dispensa- 
tory states that its leaves contain an acrid principle 
strong enough to irritate the skin. 

ANA CAEDIA CUJE. 

Rhus toxicodendron. Poison Ivy. 

Rhus venenata. Poison Sumach. 

Rhus diversiloba. Poison Oak. 

There are three species of plants growing abun- 
dantly in the United States, which have long been 
known to produce a so-called poisonous action upon 
the skin of persons touching or approaching them. 1 
These are Rhus toxicodendron, Rhus venenata, and 
Rhus diversiloba, a genus familiar to every one in the 
form of our common sumach, belonging to the family 

1 This account of the action of Rhus is based upon an article written 
fourteen years ago, which was published in the New York Medical 
Journal, March, 1873. The writer's experience since then suggests 
some additions to the information therein given, but only trivial alter- 
ations or corrections. 



32 DERMATITIS VENENATA. 

Anacardiacece. The first, R. toxicodendron, by earlier 
botanists called R. radicans, is a vine of very common 
occurrence, running over stone fences and along way- 
sides, or climbing trees to a considerable height, and 
attaching itself to these surfaces by lateral rootlets. 
It is popularly called poison ivy, poison vine, poison 
oak, mercury. The second species, R. venenata, R. ver- 
nix of Linnaeus, commonly known as poison sumach, 
poison dogwood, poison elder, poison ash, is a tree 
growing mostly in swampy places, and reaching the 
height of twenty feet or thereabout. R. diversiloba 
is the common poison oak of the Pacific coast, and 
closely resembles R. toxicodendron. Their botanical 
characters may be found in all works on our native 
sylva and flora ; but, as these descriptions are often 
very brief, and not sufficiently explicit to present a 
characteristic picture of the plants to the general 
reader, 1 and inasmuch as cases of poisoning by them 
are often the result of ignorance of their appearance, 

1 Extract from Gray's Manual : — 

" 4. R. venenata, DC. (Poison S. or Dogwood.) Smooth, or nearly 
so ; leaflets 7-13, obovate-oblong, entire. Swamps. June. — Shrub 
6°-18° high. 

" 5. R. toxicodendron, L. Climbing by rootlets over rocks, etc., or 
ascending trees ; leaflets 3, rhombic-ovate, mostly pointed, and rather 
downy beneath, variously notched, sinuate, or cut-lobed, — or else entire, 
then it is R. radicans. — June." 

Torrey and Gray give in their Manual the following description of 
R. diversiloba: "Nearly glabrous; stem scarcely climbing with short, 
leafy branches; leaves 3- (rarely 5-) foliate; leaflets very obtuse, in the 
pistillate plants slightly, in the staminate rather deeply pinnately lobed ; 
lobes very obtuse, the incisions acute; panicles axillary, racemose; 
drupes subglobose. It differs from R. toxicodendron by having acumi- 
nate leaflets and almost sessile panicles. It abounds throughout the 
Coast Range, and is the Hiedra of the Spanish colonists. It is R. lobata 
of Hooker." 



DERMATITIS VENENATA. 33 

and many perfectly harmless plants are, moreover, 
avoided on suspicion that they are either one or the 
other of these, I prefer to give in this connection, in 
brief, the more graphic and popular descriptions of 
the first two species to be found in the second edi- 
tion of Bigelow's "Florula Bostoniensis," published 
in 1824, and long out of print, — a book as fresh and 
charming still to lovers of wild-flowers as when its 
gifted author, some sixty years ago, first gathered 
and painted them. 

" Rhus vernix. L. Poisonous Sumach or Dogwood. — This 
species grows in swamps, where its fine smooth leaves give it 
the air of a tropical shrub or tree. The trunk is from one to 
five inches in diameter, branching at top, and covered with a 
pale grayish bark. The wood is light and brittle, and con- 
tains much pith. The ends of the young shoots and the petioles 
are usually of a fine red color, which contributes much to the 
beauty of the shrub. The leaves are pinnate, the leaflets ob- 
long or oval, entire, or sometimes slightly sinuate, acuminate, 
smooth, paler underneath, nearly sessile, except the terminal 
one, from seven to thirteen in number. The flowers, which 
appear in June, are very small, green, in loose axillary 
panicles. The barren and fertile flowers grow on different 
trees. The fruit is a bunch of dried berries, or rather drupes, 
of a greenish white, sometimes marked with slight purple 
veins, and becoming wrinkled when old. They are roundish, 
a little broadest at the upper end, and compressed, containing 
one white, hard, furrowed seed. 

"Bhus radicans. Poison Ivy. — A hardy climber, frequently 
seen running up trees to a great height, supporting itself by 
lateral roots, and becoming nearly buried in their bark. The 
leaves are ternate, and grow on long, semicylindrical petioles. 
Leaflets (3), ovate or rhomboidal, acute, smooth, and shining 
on both sides, the veins sometimes a little hairy beneath. The 
margin is sometimes entire, and sometimes variously toothed 

3 



34 DERMATITIS VENENATA. 

and lobed, in the same plant. The flowers are small and 
greenish white. They grow in panicles or compound racemes 
on the sides of the new shoots, and are chiefly axillary. The 
berries are roundish, and of a pale green color, approaching to 
white. Common about the borders of fields. — June." 

Rhus toxicodendron, or the poison ivy, might read- 
ily be taken to be our common woodbine, or Virginia 
creeper (Ampelopsis quinquefolia), from the manner 
of its growth, locality, and the brightness of its tints 
in the autumn. It will be seen, however, at a glance, 
as its specific name implies, that the number of leaflets 
in the latter is five, while in the poison vine there are 
but three. This will always serve as a distinguish- 
ing mark between them, even if the difference in the 
shape of the leaflets be not observed, though the very 
great variation in form in those of R. toxicodendron 
should be carefully borne in mind. It should be re- 
membered that this species also grows in bush form 
of considerable size, and covers uniform areas thickly 
as a low shrub, presenting none of the appearances 
of a vine. 

Rhus venenata , the shrub or tree, bears some resem- 
blance, as will be seen on comparison, in the shape of 
its pinnate leaves, to those of the elder {Sambucus) and 
sumach (R. typhina, or R. glabra). The serrate edges 
of these, as well as their more pointed tips, should be 
sufficient to distinguish them from this dangerous 
associate, even for persons not observant of less con- 
spicuous details. At a little distance, however, the 
common sumach might readily be confounded with 
small-leaved specimens, and considerable variation in 
the size and breadth of the leaves of the poisonous 
species, as may be seen, prevails. It may be safely 



DERMATITIS VENENATA. 35 

said, however, that several common and harmless 
shrubs and trees are feared and shunned for this a 
hundred times where the true poisonous sumach is 
once mistaken for other and innocuous plants by per- 
sons unacquainted with it ; for, although by far the 
more virulent of the two, it is of far less common 
occurrence, and grows in less frequented localities, than 
R. toxicodendron. 

The peculiar action of these plants upon the human 
skin has long been known and dreaded, but very few 
accurate descriptions of its effects are to be found either 
in books of medicine or botany. Writers have gener- 
ally regarded the inflammatory affection of the skin 
provoked by contact with the plants, or their emana- 
tions, as of an erysipelatous nature, an opinion quite 
as erroneous as many of the fanciful notions prevalent 
concerning its character. Bazin, for instance, in his 
" Affections Cutanees Artificielles," says : " Je dois 
enfin vous dire quelques mots des singuliers effets 
produits par deux plantes que croissent en Amerique, 
le Rhus radicans et le Rhus toxicodendrum. De ces 
arbustes se degagent incessamment, si Ton en croit 
les auteurs, des emanations irritantes et toxiques au 
plus haut degre ; malheur a l'imprudent qui s'aban- 
donne au sommeil sous leurs ombrages ! son corps 
se couvre presque aussitot d'un exantheme ve'sicu- 
leux, avec gonflement enorme, et en meme temps se 
declarent des symptomes generaux qui prennent la 
forme d'un veritable empoisonnement aigu, et dont 
la violence peut entrainer la mort dans un temps 
tres court." 

After this there should be no doubt either as to 
the existence or habitat of the fabled upas tree. 



36 DERMATITIS VENENATA. 

Van Hasselt, in his " Giftlehre," speaks of the 
effects of the poison as a painful dermatitis, either 
in the form of an urticaria, erythema, or erysipelas 
bullosum, which may terminate in an extensive and 
protracted suppuration. 

Observation of a few cases, as they present them- 
selves in the practice of every physician, will satis- 
factorily establish the changes in the skin to be those 
of a dermatitis of eczematous type, although so severe 
in some cases as to produce quite as marked deform- 
ity of parts as true erysipelas. As the character of 
these changes can be best studied by daily observa- 
tion throughout their ivhole course, and as such op- 
portunities are not often afforded, I preferred to 
create one for my purpose. In the study of botany 
and ornithology I have spent a good deal of lei- 
sure time in woods and fields during the past thirty 
years, and have always collected without gloves. I 
had never, however, been poisoned by ivy, although 
I had never specially shunned or sought contact 
with it. 

Case I. — On September 28 I picked a large bunch 
of the gorgeously tinted leaves of Rhus venenata from 
a tree some ten feet high, growing in a swamp in 
Dedham. It was a warm and sunny afternoon, and, 
my botanical box being filled with other specimens, 
I brought them home in my hand, from the palm of 
which the epidermis had been torn in several places 
a few minutes before by falling upon the uncut, splin- 
tered portion of a stump. They were carried in this 
hand at least an hour and a half, and during the 
evening were repeatedly handled while arranging 



DERMATITIS VENENATA. 37 

them for the herbarium. Some of the still green 
and unchanged leaves were also picked. The con- 
ditions were thus as favorable as possible for the 
absorption or action of the poison. Not the slightest 
effect was produced upon the skin, however. I 
thought I felt during the evening, while working 
over them, directly beneath the heat of an argand 
gas-burner, a sensation of irritation or acridity about 
the eyes and throat. They were subsequently han- 
dled freely for ten days every morning, while changing 
the driers in the press. 

October 6. — I picked at Fresh Pond a large quan- 
tity of R. toxicodendron, specimens changed to autumn 
tints, and others still of a glossy green, from plants 
running over stone walls and climbing high trees. 
Both leaves and stems were collected. These, too, 
were handled freely on a warm afternoon, and re- 
peatedly afterward in the press. It was absolutely 
inactive upon my skin. 

October 10. — I again visited the swamp where the 
poison sumach, or dogwood, grows in abundance, after 
specimens of the fruit, but failed to obtain them. I 
picked many of the brilliant leaves, however, and 
twigs, and branches, with foliage still unchanged in 
color. The juice, which exuded freely from the 
broken wood, was rubbed upon my hands in several 
places and allowed to dry there, and the leaves 
touched my face repeatedly while gathering them. 
I again thought I perceived in my air-passages and 
eyes at the time, and later in the evening again while 
pressing the specimens, the same impression of acrid- 
ity. Nothing was noticed upon the skin indicating 
any action upon its tissues until, two days later 



38 DERMATITIS VENENATA. 

(October 12), a single vesicle, with the peculiar thick 
cover and somewhat dark look so often seen, appeared 
upon the back of a finger, but accompanied by no 
sensation. 

October 13. — The third day, a single and similar, 
though somewhat larger, vesicle appeared upon my 
left wrist ; to which two others joined themselves on 
the following or fourth day, thus making a very 
small group. At the same time — that is, the 14th 
— a single additional vesicle showed itself some three 
quarters of an inch from the first-comers upon the 
finger and wrist. 

October 17. — One of the vesicles which appeared 
last upon the knuckle, without any external irrita- 
tion, increased to three times its original size, with 
burning and itching sensations. The other efflores- 
cences quiescent or receding. 

October 19 (no specimens having been handled for 
a week). — A new and very large vesicle of irregular 
shape appeared on the back of the last phalanx of 
the right thumb, covered with so thick a roof as to 
appear untransparent, as if the effusion had taken 
place in the lowest layer of the rete mucosum. 

October 21. — Two new vesicles, one on the back 
of the left forefinger, the other on the thumb near 
its base. 

October 23. — All the groups, old and new, have 
become enlarged by the appearance of new vesicles 
at the peripheries (excepting those upon the wrists, 
which had been opened for the purpose of an experi- 
ment described below), and one new cluster appeared 
on the back of the right middle-finger. All itch and 
burn extremely. 



DERMATITIS VENENATA; 39 

October 26. — The original vesicles and papules 
have, in many of the clusters, resolved themselves 
apparently into two or three times their number of 
smaller efflorescences, the whole patch flattening down 
and assuming a darker brown tinge. 

October 27. — A large single vesicle, with the 
thick and opaque covering peculiar to its seat, has 
struggled up into distinct prominence in the palm of 
the right hand, near its ulnar border ; a fresh one 
also at the base of the nail of the left thumb. At 
this date there are seven single or groups of efflo- 
rescences on different parts of the hands, hi all stages 
of development or involution. 

November 1. — Another small vesicle has appeared 
in the right palm, half an inch from that of October 
27. The earlier vesicles have nearly all flattened 
down to the level of the general surface. 

November 3. — A single vesicle shows itself upon 
the internal lateral surface of the left thumb. This 
was the last to appear, and from this date all the 
efflorescences gradually subsided, and after a fort- 
night were no longer perceptible. At the present 
time, November 26, their seats are still defined by 
the more glossy look of the new epidermis which 
covers them. 

This may be taken as a description of the effects of 
the poison upon the human skin in its mildest form. 
The changes, however, as described, are typical of the 
peculiar efflorescence in all cases. In what respects 
it falls short of the manifestations in its severest 
forms may be learned by comparison with the his- 
tories of the following cases. 



40 DERMATITIS VENENATA. 

Case II. — Several years ago I was called to see a 
young lady, who a few days previously had come 
in contact with poison ivy while gathering autumn 
leaves. Her whole head was greatly swollen, and the 
features were so distorted that no one could recognize 
her. On close inspection, the skin of the face and 
neck was felt to be deeply cedematous, and was 
largely covered with vesicles of all sizes, many of 
which were seated on an erythematous base, others 
being still in their papular stage of development. 
There were also numerous large excoriations, from 
which fluid was freely exuding, stiffening in places 
on drying and forming soft crusts. The ears were 
much thickened, and were dripping with the escaping 
serous exudation. The hands were also affected, 
being thickly covered upon their backs with groups 
of small vesicles, while upon the palms numerous 
vesicular exudations were dimly seen beneath the 
thickened epidermal coverings, trying to push them- 
selves above the level of the general surface. The 
other parts of the body were unaffected. The sub- 
jective symptoms were great itching and burning of 
the parts affected, with the feeling of local discom- 
fort consequent upon so great swelling of the features. 
The eyes were nearly closed. There was a slight 
general febrile action. 

New efflorescences continued to appear for several 
days ; but the course of all the cutaneous manifesta- 
tions was abbreviated, and the oedema immediately 
reduced, by the local treatment which was employed. 

The following year, the same patient, then nineteen 
years old, was bathing at the sea-shore in August, and, 
while climbing up from the water over the rocks, her 



DERMATITIS VENENATA. 41 

bare knee and leg came in contact with the poisonous 
vine. I saw her a few days afterward. There was 
then a long strip of reddened skin, several inches in 
width, covered with vesicles and a few papules, run- 
ning upward and downward from the knee. The chin 
was occupied by a large group of papules, a few of 
which had already advanced to the vesicular stage. 
The skin beneath one eye was also puffed and red- 
dened. The further progress of the affection was 
quickly checked by local applications, and, as in the 
previous attack, the effects of the poison at the end of 
some two weeks had entirely disappeared. 

Three years afterward, at New Year's time, I was 
again called to see this young lady. Her face and 
hands were affected in a manner similar to that first 
described, though the inflammatory process was less 
severe. The parts were less swollen, but there was an 
abundant eruption of the vesicles and flow of serous 
exudation from the excoriated parts. The appear- 
ances were wholly characteristic of ivy poisoning, yet 
she had not been out of the city, and it was mid- 
winter. On inquiry, I found that a box of Christ- 
mas greens had been received from the country, which 
she had used in decorating the house. Among them 
were sprigs of poison ivy leaves, the cause and expla- 
nation of the attack. 

Case III. — Late in October, 1871, 1 was called to 
see a gentleman who, in cleaning up his grounds at 
the sea-shore a few days previously, had handled the 
poison vine which grew upon the place in great abun- 
dance. His hands, especially the lateral surfaces of 
the fingers, were then thickly covered with vesicles, 



42 DERMATITIS VENENATA. 

and his face and genitals were badly swollen. The 
following day the eruption appeared upon the arms, 
and about the thighs and abdomen, and continued to 
spread for several days, until at last it presented the 
following appearances. 

The face and ears were of a lurid red color, greatly 
swollen, and dripping with fluid exudation. The neck, 
chest, and abdominal wall were also reddened, and oc- 
cupied by large patches of flattened papules and vesi- 
cles, and by moist excoriations. The genitals were 
enormously distended by oedema, and the scrotum was 
running with serum. The arms and legs were also 
oedematous, and largely occupied by fields of the pe- 
culiarly characteristic vesicles of the affection. The 
patient was of a highly nervous temperament, and suf- 
fered tortures from the severe itching which accom- 
panied the eruption. The skin was so universally 
irritable that no clothes could be worn for forty-eight 
hours when the affection was at its height, and a sheet 
or blanket was the only covering tolerated during this 
time. Sleep without powerful anodynes was impossi- 
ble for several nights in succession. There was but 
little fever or constitutional disturbance, however. Ap- 
plications were almost constantly made to the whole 
surface, and after the seventh or eighth day from the 
first appearance of the eruption there were no new 
manifestations, and the skin rapidly returned to its 
natural state. 

These cases may be taken as representatives of the 
severer forms of poisoning, as they ordinarily occur, 
and they are among the severest of my own experience. 
To what further development they might have ex- 



DERMATITIS VENENATA. 43 

tended without treatment it cannot be said. There are 
reports, however, of still graver effects. Dr. Bigelow, 
in his " Medical Botany," quotes Kalm as saying, in his 
Travels, that he had known persons to be so swollen 
by the exhalations of Rhus venenata as to be as stiff as 
a log, and capable of being turned about only in sheets ; 
and Dr. Thacher's report of a case in which the head 
and body were swollen to a prodigious degree, so as to 
occasion loss of sight for some time, as well as the loss 
of the hair and nails. Dr. Bigelow adds, that he 
had been told of cases in which death appeared to be 
the consequence of this poison, although he had never 
known a fatal case. 1 

Whether these extraordinary results thus mentioned 

1 I am permitted to publish in this connection the following account 
of a case which occurred many years ago in the family of a Professor in 
our University. 

" My wife's brother, of Brookline, a child of six years, died of poison by ivy 
in the autumn of 1819, having been twice before poisoned during the previous 
summer. The circumstances were these. 

" A servant-boy living in the family, being insusceptible of poison by ivy, 
had been employed in pulling up all the vines of that plant found growing in 
the grounds about the house. When his task was finished, he was made to wash 
his hands thoroughly with hot water and soap, and afterward with vinegar. 
Mrs. — , who feared that the boy, notwithstanding his supposed invulnera- 
bility, might possibly be injured by so much handling of the poisonous stuff, 
stood by to enforce the operation. In the afternoon, at his own request, he was 

allowed to take little R to Jamaica Pond for a bath. Having stripped the 

child, he immersed him, holding him with his hands under the armpits, and 
afterward rubbed his back with his open palm. 

" After two or three days the child was taken ill, and grew rapidly worse. 
Deep ulcers made their appearance under the armpits, and the skin of the back 
exhibited in aggravated form the usual marks of poisoning by ivy. He died at 
the end of the third week of his sickness. The attending family physician was 
the late Dr. Wilde. 

" The child had been healthy, although not robust. Perhaps the two pre- 
vious poisonings, from which, however, he seemed to have perfectly recovered, 
had weakened the power of resistance in the constitution, and so contributed to 
the fatal result of the last attack. He died on the 6th of October. 

"Cambridge, December 24, 1872." 



44 DERMATITIS VENENATA. 

by Dr. Bigelow are to be referred to the legitimate 
action of the poison, or to some peculiar and excep- 
tional condition of the persons when exposed to it, 
cannot now be determined. However, they in no way 
affect the conclusions to be drawn from the history of 
the cases I have cited in relation to the character of 
its cutaneous manifestations. In these, and in the 
hundreds I might quote from personal observation, 
the pathological changes of the skin are identical, 
differing only in degree of intensity and extent of 
distribution. In the mild case, a slight erythema, a 
papule or vesicle, and a small underlying infiltration 
or exudation. These are all the phenomena observed, 
whether we have a single efflorescence or several indi- 
viduals grouped together. Variations in the course 
and development of the different lesions do occur. 

Taking the simple vesicle, with scarcely any ery- 
thema surrounding it or any very perceptible infil- 
tration of the underlying tissues, as the type of the 
eruption, whether occurring singly or in groups, we 
may have in a small percentage an abortive attempt 
at vesiculation, and an arrest of development at the 
papular stage, — a failure, that is, of the free exuda- 
tion to force apart the layers of epithelial cel]s ; or a 
considerable infiltration into the papillary layer may 
elevate a cluster of the vesicles noticeably above the 
general surface ; or they may be surrounded by a well- 
defined erythema or congestion of the tissues immedi- 
ately surrounding them, in consequence mainly of the 
scratching provoked by the local burning and itching, 
which are the only subjective symptoms present. 

In the severe cases, we have greater areas of simple 
erythema, a multiplication of the number of vesicles, — 



DERMATITIS VENENATA. 45 

either single or massed in close contiguity, and cov- 
ering large surfaces, or by fusion forming blebs, — a 
greater infiltration into the underlying corium, with 
proportionate distention of the capillaries and external 
redness, and a free exudation of serum into the cutis. 
The overfilling of the vesicles causes a rupture of some 
of their epidermal coverings, and the discharge of their 
fluid contents upon the surface, forming moist, excori- 
ated surfaces, covered in part with crusts. 

These, it will be seen, are the well-recognized lesions 
that characterize the inflammatory process of the skin 
which we call eczema, and, if opportunity were afforded 
for fine dissection, we should no doubt find the same 
pathological changes of tissue which constitute the 
infiltration, papule, and vesicle formation of the pro- 
gressive stage of idiopathic eczema. It may be that 
there are skins so peculiarly constituted, or conditions 
of such intense virulence of the poison, that a deep- 
seated dermatitis or phlegmonous erysipelas may be 
excited under its influence ; but I have never seen 
them, and doubt their occurrence. The constancy of 
type in the tissue changes, in every case and of all 
grades observed by me, is satisfactory evidence that 
the affection is always of an eczematous type. 

If, then, the cutaneous manifestations of ivy poi- 
soning are mainly those of eczema, have they no indi- 
viduality, no characteristic marks by which they may 
be distinguished from those of the idiopathic affection ? 
There are differences to be recognized by the practised 
eye, but they are more easily detected than described. 
First, with regard to peculiarities in the seat of the 
eruption upon the hands, the parts naturally the most 
frequently affected. It appears most easily, one may 



46 DERMATITIS VENENATA. 

say, and therefore generally first, upon the lateral sur- 
faces of the fingers, or along their edges, later upon 
the dorsal surfaces, and latest upon the thickened 
palms. It is more scattered, more irregular in its 
distribution, than the eruption in ordinary eczema. 
The character of the efflorescence, too, is strikingly 
peculiar, though indescribable. It is more uniformly 
vesicular than vesicular eczema. The vesicles seem to 
be born vesicles without having gone through an inter- 
mediate papular stage of development. They appear 
somewhat less transparent, as if the effusion had 
taken place in the lowest cells of the rete Malpighii, 
and have generally a peculiar tinge of color, which 
can only be called lurid. Upon the palmar surface 
their epidermal coverings are so dense that they look 
and feel more like papules, but the fluid character of 
their contents may yet be dimly seen and brought to 
the surface by puncture with a needle. Some pecu- 
liarities, too, may be noticed in the distribution and 
configuration of the eruption. It often occurs in 
sharply defined patches, elongated streaks, or irregu- 
lar shapes, as marked out by the original contact with 
the plant. The genitals are almost always affected, in 
both sexes, when the hands are the original seat of the 
disease, as their vicinity is the natural resting-place 
of the latter during sleep, and patients often fail to 
wash them sufficiently, or at all, before going to bed, 
after handling the plant during the day. These are 
some of the differences, minute it is true, but still 
sufficiently characteristic to an experienced observer, 
by which a case of Rhus poisoning may generally be 
recognized and distinguished from idiopathic eczema. 
In some mild cases, however, it is impossible to deter- 



DERMATITIS VENENATA. 47 

mine positively whether we have a case of the one or 
the other before us. 

In its later stages, those of retrogression or involu- 
tion, the skin returns to its natural state without any 
marked change in the character of the eruption. In 
the mild cases, the process of inflammation is seldom 
carried so far as to transform the vesicle into a pus- 
tule, and after reaching its height its serous contents 
are slowly absorbed, and it flattens down, leaving a 
fugitive, dull-colored stain to mark its seat at times. 
In the severer forms, the oedema and erythema rapidly 
subside under treatment, and the excoriations, crusts, 
and infiltration disappear in the same manner as in 
an ordinary case of acute eczema. 

The duration of these alterations of the skin, ac- 
cording to their severity, varies less than would be 
believed without close observation. In my own case 
(one of the mildest and untreated), vesicles continued 
to appear from October 12 to November 3, and the 
whole period of development and involution was from 
five to six weeks. In the severest attacks, where the 
changes of tissue reach their highest possible develop- 
ment and affect large surfaces of the body, the dura- 
tion is seldom, if ever, more protracted than this, and 
the individual efflorescences run as rapid a course as 
those of the same degree of development in the for- 
mer. The duration of an attack depends largely upon 
the protraction of the period during which fresh efflo- 
rescences manifest themselves. Under local treatment 
constantly applied, this period, without reference to 
what may be called the sequelae, which will be spoken 
of below, according to my own experience, generally 
lasts from ten to fourteen days from the appearance 



48 DERMATITIS VENENATA. 

of the eruption. To this is to be added the neces- 
sary time for the natural involution of the efflores- 
cences last to appear, according to the degree of 
development to which they severally attain, from ten 
to fourteen days more, and we have for the ordinary 
course of the affection a period of from three to four 
weeks. How long it might continue without treat- 
ment in severe cases I have no means of knowing, 
except the observation of my own very mild case, in 
which fresh vesicles were developed for twenty-two 
days. On the other hand, mild cases occasionally run 
through their whole course within ten days or a fort- 
night. 

Sequelce. — The question of duration leads us natu- 
rally to consider that of other possible effects of the 
poison upon the skin or general economy, subsequent 
to what we may call its primary action above de- 
scribed. There are several popular beliefs bearing on 
this point, which have perhaps some foundation in 
facts improperly observed and illogically used. An 
opinion prevails, for instance, that in a year after the 
first attack there will be a repetition of the original 
manifestations upon the skin, which may be repeated 
for several seasons. Another is entertained, that a 
variety of cutaneous affections are developed in con- 
sequence of its action, at indefinite periods, and even 
long after the first attack. If there be any appar- 
ent ground for the former, it is mere coincidence in 
point of time, misapplied to circumstances which have 
given rise to the latter; for no elements of periodi- 
city in any subsequent possible manifestations of the 
poison have been established, so far as I know. There 
may be some reasons, however, for the belief that cer- 



DERMATITIS VENENATA. 49 

tain diseases of the skin sometimes follow Rhus poi- 
soning. I have had many patients who have ascribed 
the development of various of these affections to such 
cause. They say, " I always had a healthy skin until 
I was poisoned by ivy, and afterward it was affected 
in this way," after an interval of weeks, months, or, 
it may be, years. In the existing impossibility of de- 
termining the cause of diseases of the skin except 
in very rare instances, it is not strange that people 
should refer subsequent affections of its tissues to 
the continued or intermittent action of an agent ca- 
pable of producing at first such striking and severe 
changes as they have once experienced, and that they 
in many instances should ascribe as a cause what is 
only an irrelevant preceding event. Yet there are, 
I think, good grounds for the belief that certain af- 
fections of the skin do follow poisoning by Rhus in 
some cases, which would not otherwise have occurred. 
This, however, by no means authorizes the conclusion 
that they are directly caused by its action, or are in 
any way specific in their character. There is no evi- 
dence, I think, of a continuance or renewal of the 
operation of the poison, after its primary impression 
upon the skin has exhausted itself. The characteris- 
tic features of the cutaneous manifestations of this 
period do not repeat themselves in the subsequent 
affections, which, I think, may be fairly referred to 
the prior poisoning as an indirect cause. They are 
forms of ordinary eczema, and, in rarer instances, of 
acne only, so far as my observation teaches. I have 
already referred to the many patients with these com- 
mon diseases of the skin who have ascribed them to 

having been at some previous time poisoned by ivy. 

4 



50 DERMATITIS VENENATA. 

I prefer to use in this connection, however, for confir- 
mation, another class of cases, those, namely, in which 
I have seen these affections develop subsequent to 
such attacks of poisoning as have also occurred under 
my personal observation. 

1. A young lady, having been badly poisoned in Oc- 
tober upon the face, after a rapid recovery, had in the 
following January an attack of facial eczema. 

2. Another young lady, after severe poisoning of 
the face and hands, had in a few months an outbreak 
of facial acne. 

3. An old gentleman, whose hands had been a short 
time previously poisoned, had, immediately following 
his recovery, an eruption of eczema covering his arms. 

4. A young man, after being severely poisoned in 
the face, was immediately attacked by acne of the 
part, which lasted a long time. 

- 5. A gentleman of middle age was poisoned upon 
the hands and forearms. A few months afterward he 
had an obstinate subacute eczema of the legs. 1 

In all these cases, it is to be understood, the second- 
ary affection mentioned occurred for the first time in 
the patient's history, and after the specific primary 
manifestations of the poisoning had disappeared. It 
is impossible to say that just the same affections might 
not have appeared at just these times, even if the sub- 
jects of them had not been previously poisoned, because 
they are of such frequent idiopathic occurrence ; but, 

1 Dr. Bigelow, in his " Medical Botany," states that Dr. Pierson, 
who was badly poisoned while assisting him in the experiments with the 
juice of Rhus venenata, had eczema of his hands for a year afterward. 



DERMATITIS VENENATA. 51 

considering that eczema and acne are pathological 
conditions of the skin of such a nature as might 
readily follow the disturbance in its tissues and glands 
necessarily consequent upon severe poisoning by Rhus, 
it should not be considered illogical to refer their ap- 
pearance under such circumstances to the morbid im- 
pression it may have left upon them. These, however, 
are the only possible sequelae in my experience that 
might be so interpreted. 

Susceptibility to its action seems never to diminish 
in the same individual, however often affected by the 
poison. On the other hand, I have observed that per- 
sons who have always handled Rhus toxicodendron 
with impunity become more susceptible to its influ- 
ence after having been poisoned by the more virulent 
Rhus venenata. Such is my personal experience. 

Chemical Nature of the Poison. — What the real 
nature of the poisonous principle contained in these 
plants, capable of producing such peculiar and severe 
effects upon the human skin, might be, was largely a 
matter of conjecture, in spite of many attempts to 
reach it by chemical processes, until a few years ago. 
Knowledge that its emanations were often as active 
as contact with the plant, of course, suggested its 
volatile nature, but all attempts to isolate and fix 
it were in vain. The yellowish, milky juice which 
exudes from the broken or bruised parts of the plant 
possesses, as is well known, the property of changing 
to a brilliant black after a short exposure to the air, 
and of producing an indelible black stain upon cellu- 
lose. The beautiful lacquer of the Japanese is made 
from the juice of a species of rhus closely allied to 
our native plant. Professor Gray, in his interesting 



52 DERMATITIS VENENATA. 

address on " The Sequoia and its History/' to the 
American Association for the Advancement of Sci- 
ence, says : " Our Rhus toxicodendron, or poison ivy, 
is very exactly repeated in Japan, but is found in no 
other part of the world, although a species much like it 
abounds in California. Our other poisonous Khus (R. 
venenata) is in no way represented in Western Amer- 
ica, but has so close an analogue in Japan that the 
two were taken for the same by Thunberg and Lin- 
naeus, who called them both Rhus vernix" Of the 
history of the preparation of this celebrated varnish 
of Japan, and its effects upon the workmen engaged 
in its manufacture and use, very little is known. As 
early as a. d. 701, artificial plantations of Rhus verm- 
cifera were established. Every farmer in certain parts 
of the country was obliged to plant, and taxes were 
paid in lacquer. Sap is first taken when the trees 
are three years old, but the best quality is not ob- 
tained until they have attained the age of fourteen or 
fifteen. They bear sap until they are thirty or forty. 
The wild trees are tapped when five years old, from 
the end of May until the end of October^ incisions 
being made in the bark extending about one quarter 
of the trunk's circumference, and just deep enough to 
reach the wood. A clear sap flows out, mingled with 
a very white milky substance, which darkens very 
soon when exposed to the air, and gradually assumes 
a dark brown, and almost black color. The best qual- 
ity is of a light yellowish hue, and is gelatinous. It 
is preserved in bamboo tubes to prevent its turning 
black. The lacquer is taken from the incisions as 
soon as they are filled, with an iron spatula. After 
three or four days new incisions are made, and the 



DERMATITIS VENENATA. 53 

process is continued in this way until the end of the 
season, when the tree is cut down. Several varieties 
of lacquer are made, one of the best forming a bril- 
liant transparent coating of a yellowish tint, allowing 
the grain of the woods to which it is applied to be 
seen through it. The darker varieties are made by 
frequent stirring for several days with a little water, 
or with the smudge which is caught in the trough 
under a grinding-stone. Others are mixed with prep- 
arations of iron, cinnabar, charcoal, gold-leaf, and 
other substances. 1 

In Kaempfer, " Amcenitatum Exoticarum " (1712), 
I find, through the kindness of Prof. Gray, an allusion 
to the action of the varnish upon those engaged in its 
use, as follows : " Vernix exsperat halitum, ex quo 
labia tumescunt, et caput dolet ; unde in deliniendo 
artifices strophiolo os et nares obligant." 

I have heard of a person who had been poisoned 
by the presence of imported lacquered ware in apart- 
ments, but I report the case only on " hearsay " evi- 
dence. Some of the embossed Japanese papers, which 
have been used so much upon the walls of our houses 
recently, have produced severe inflammation of the 
hands of the hangers, presumably in consequence of 
the abundant lacquer with which they are covered. 
Dr. H. N. Allen, of Korea, writes to the "Journal 
of Cutaneous and Genito-Urinary Diseases," Janu- 
ary, 1887, from that country, that many foreigners, 
as well as natives, in the East are often troubled by 

1 For accounts of the preparation of the lacquer, see Transactions of 
the Asiatic Society of Japan, Vol. IX. Part I., and the official Catalogue 
of the Japanese Section of the International Exhibition at Philadelphia, 
1876, — references for which I am indebted to Prof. Morse of Salem, 
author of " Japanese Homes." 



54 DERMATITIS VENENATA. 

" varnish poisoning,' ' which is in some cases so dis- 
tressing that the person cannot pass a furniture shop 
where articles are being varnished, without being poi- 
soned. With others it comes on after actual contact 
with furniture freshly varnished. He has noticed that 
comparatively old articles possess the poisonous prop- 
erty during the rainy season, when everything is cov- 
ered with dampness. He himself had had an attack in 
Nanking, and another in Shanghai. The treatment 
there advised was constant bathing with an infusion of 
fresh camphor-wood shavings. 

In 1857 Dr. Khittel made an analysis of the con- 
stituents of Rhus toxicodendron, a translation of which 
appeared in the " American Journal of Pharmacy," 
1858. He came to the conclusion that its active prin- 
ciple depended on a volatile alkaloid, obtained by 
distilling an infusion of the dried leaves. As the 
active principle is so volatile that the leaves give up 
a large part of their poison while drying, it is evi- 
dent that boiling down an infusion of them would, 
as Professor Maisch says, be the best method for 
obtaining the least possible quantity of the poison- 
ous principle, if, indeed, it could be obtained by this 
process at all. 

In 1865 Prof. John M. Maisch published the first 
satisfactory account of the chemical nature of this poi- 
son in the proceedings of the American Pharmaceutical 
Association. He began his investigation by attempting 
to extract and preserve this alkaloid, but satisfactorily 
demonstrated that it does not exist, even in the fresh 
plant. He then enclosed some fresh leaves in a tin 
box and introduced some moistened test-papers. The 
next morning the curcuma and red litmus-papers were 



DERMATITIS VENENATA. 55 

unaffected, but the blue litmus-papers had been colored 
strongly red, proving that the exhalations contained a 
volatile acid. This acid was extracted by two differ- 
ent processes, which it is unnecessary to repeat here. 
It was colorless, strongly affected blue litmus, and 
neutralized bases, the salts with the stronger bases 
giving a distinct alkaline reaction. With a great 
variety of reagents it gave reactions identical with 
those of formic and acetic acids, but its behavior with 
oxide of silver, nitrate of silver, oxide of mercury, 
and corrosive sublimate proved its individuality, and 
established its character as a new organic acid, for 
which Prof. Maisch proposed the name toxicodendric 
acid. 

" That it is the principle to which the poison-oak 
owes its effects on the human system, was proved to 
my entire satisfaction,' ' he says, "by the copious 
eruption and the formation of numerous vesicles on 
the back of my hand, on the fingers, wrists, and bare 
arms, while I was distilling and operating with it. . . . 
I may state here," he tells us in the early part of his 
communication, " that I have frequently collected the 
leaves, flowers, and fruit of Rhus toxicodendron with- 
out ever experiencing any ill effects. I have handled 
all parts of the plant with impunity, and have even 
spread the juice over my hands, without feeling more 
than a slight itching upon the upper side of the hand, 
which immediately disappeared on washing the hands 
with water. In a word, I considered myself so little 
subject to its influence that I collected the leaves for 
all these experiments myself. I could hardly expect 
to try the efficacy of the poisonous principle, when 
isolated, upon my own person ; the result, however, 



56 DERMATITIS VENENATA. 

proved to be very different. Several persons, coming 
into the room while I was engaged with it, were more 
or less poisoned by the vapors diffused in the room ; 
and I even transferred the poisonous effects to some 
other persons, merely by shaking hands with them." 
(Whether after washing hands ?) " The dilute acid, 
as obtained by me, and stronger solutions of its salts, 
were applied to several persons, and eruptions were 
produced in several instances, probably by the former, 
though not always, which was most likely owing to 
the dilute state of the acid. Whenever this was 
boiled, I always felt the same itching sensation in 
the face and on the bare arms which I experience on 
continual exposure of my hands to the juice of the 
plant. . . . Whether the toxicodendric acid is, to a 
greater or less extent, lost in drying, I am as yet 
unable to say." As regards its isolation it is easily 
effected, and the expressed juice, preserved by alcohol, 
he believes to be the best preparation. Prof. Maisch 
closes his interesting communication with the promise 
that, if time permits, he may attempt to prepare the 
acid in more concentrated form, and to determine its 
composition. It is to be regretted that, as he states 
in a letter to me, he has thus far been unable to make 
further researches concerning it. There can be little 
doubt, I think, of the correctness of these views with 
regard to the chemical nature of the poison, as they 
are entirely consistent with our knowledge of its 
action upon the human system. 

How far this volatile principle may be carried in 
the air in a sufficiently concentrated form to produce 
its peculiar effects upon the skin, cannot be exactly 
stated, but it must vary with the degree of individual 



DERMATITIS VENENATA. 57 

susceptibility. I have been assured by persons well 
acquainted with the plant, and so easily acted upon 
as to have been repeatedly poisoned by it, that they 
have been affected by driving along a narrow road, 
the stone walls on either side of which were cov- 
ered with the flowering vines of Rhus toxicodendron. 
Many persons who carefully shun contact with it are 
frequently poisoned when they approach it even. That 
very slight contact is sufficient to produce very severe 
action upon the skin at times, is certain. The meas- 
ure of the extent of its power can be learned by 
experience alone, — some persons being entirely un- 
affected by ordinary handling of specimens, who are 
yet susceptible in some degree to its action in a con- 
centrated form. My own case, and the experiments 
of Prof. Maisch above quoted, illustrate this. 

The two species differ only in the degree of their 
action, — Rhus venenata, the tree, being much more 
powerful than the creeping R. toxicodendron ; and 
many persons are able to handle the latter with 
impunity, who are readily poisoned by contact with 
the former. It is evident, then, that cases of poison- 
ing would be much more frequent and severe were 
poison-sumach of as common occurrence about dwell- 
ings as the poison-ivy, for the majority of persons 
are, no doubt, unaffected by the latter. As it is, cases 
occur very frequently. The number treated at the out- 
patient department of the Massachusetts General Hos- 
pital in 1885 was twenty-five ; and during the month 
of July of this year ten patients applied there for 
relief who had come in contact with one or the other 
species. In California Dr. Canfield, in an article 
published in the " Pacific Medical and Surgical Jour- 



58 DERMATITIS VENENATA. 

nal," estimates that from five hundred to one thousand 
persons are constantly suffering from the poisonous 
action of R. diversiloba. 

Poisoning takes place, in my experience, mostly in 
the following ways : by plucking leaves while walk- 
ing along fences and roadsides, in ignorance of their 
nature ; by brushing against the plants while stroll- 
ing through woods ; in processes of husbandry, — 
clearing away vines from walls, etc., digging up roots, 
mowing, chopping wood, and the like ; by going in 
swimming and passing through plants while naked, 
or undressing in the midst of growths, along edges of 
beaches or streams ; and by gathering the most bril- 
liant autumn foliage that occurs in our flora. 

Great quantities of R. toxicodendron are gathered 
for medicinal purposes in all parts of the United 
States. One dealer in North Carolina offers in his 
stock of native drugs over three hundred pounds of 
poison-oak leaves ; and a wholesale manufacturer of 
medicinal preparations in Boston informs me that the 
workmen in his laboratory are often poisoned by its 
fumes. 

With regard to the influence of season upon the 
virulence of the poison, there is an impression that it 
is most active in the flowering season, and the ema- 
nations at such times may be especially so, while the 
skin on hot days, and when perspiring, may be most 
ready to absorb it. This may be correct ; it is, how- 
ever, sufficiently powerful at all seasons. At least 
one half of the cases I have seen have occurred in 
the autumn, after the change in the foliage, and 
in persons who, collecting autumn leaves, had been 
attracted by the gorgeous coloring both species then 



DERMATITIS VENENATA. 59 

exhibit. No leaves approach in variety and brilliancy 
of tints those of Rhus venenata. But later still in the 
season the venomous properties of these plants mani- 
fest themselves. In winter, even, cases of poisoning 
occur, and are no doubt sometimes unrecognized. In 
the case of the young lady cited in illustration of 
the severer form of poisoning, one of the attacks, it 
will be remembered, was caused by handling twigs 
and dried foliage of Rhus toxicodendron at Christmas 
time. Other cases might be reported at length, but 
it will be enough for the purpose simply to mention 
them. 

Some years ago, in December, I was called to a 
gentleman who had a severe attack upon his hands, 
caused by handling some of the branches while chop- 
ping wood. 

Last February I treated a gentleman for quite a 
severe attack upon the hands, who handled wood en- 
twined by poison-ivy out of doors, and whose farmer 
at the same time was very badly poisoned while chop- 
ping the same wood. 

Dr. Bigelow states, in his " Medical Botany," that 
he has known persons to be poisoned in the winter, 
when the wood of Rhus venenata was burned upon the 
fire. Whether in these cases the poisoning was pro- 
duced by the exhalations of the burning wood, or by 
contact while handling it by the fireside, he could not 
positively say. 

Every winter boys in this vicinity are poisoned by 
cutting the straight branches of Rhus venenata for 
hockie-sticks, which grows abundantly around the 
edges of the frozen swamps and ponds on which they 
are skating. 



60 DERMATITIS VENENATA. 

Thus not only the leaves, but the wood and bark, 
contain the virulent principle at all seasons, and 
the fruit also possesses poisonous properties when 
swallowed. 

I was curious to know how long dried specimens in 
the herbarium might retain their poisonous proper- 
ties, and for this purpose wrote to Professor Gray, who 
very kindly replied as follows : — 

Botanic Garden, Cambridge, Mass., 
October 21, 1872. 

Dear Doctor, — My personal knowledge that Khus dried 
specimens are harmless amounts merely to this: I handle 
over and over dried specimens with impunity, but am very 
sensitive to the fresh plant. Then the poison is volatile, as 
shown by its affecting persons who do not touch it actually ; 
that of the leaves, I should say, must escape and dry out in 
the drying process, or in the course of time. In a stem it 
would not volatilize so soon ; but I should not expect to be 
poisoned from any old herbarium specimen, either from twigs 
or leaves. . . . 

The time required for the development of the visi- 
ble manifestations of the poison upon the skin, after 
contact with the plant or its emanations, or its period 
of apparent latency, seems to vary greatly. In his 
" Genera," Gray says, " The symptoms begin several 
hours after exposure." Dr. Bigelow, in his remarks 
on R. venenata, says, " The effects show themselves 
upon the skin generally within eight hours." My 
own observations do not agree with these as to the 
rapidity of its action. In my own case, above re- 
corded, at least forty-eight hours passed before any- 
thing was felt or seen upon the parts to which R. 
venenata was applied. It may be properly suggested, 



DERMATITIS VENENATA. 61 

in explanation of such delay, that my skin is not 
easily acted upon by the poison. This is true, but 
my other observations concern patients, that is, per- 
sons especially susceptible to its action ; and I find on 
reference to my record-book that three days, four 
days, and five days are repeatedly given by them as 
the interval between contact and the appearance of 
an eruption sufficiently marked to attract their at- 
tention. Such length of interval seems to be by no 
means an exception in my experience, although this, 
of course, does not invalidate the correctness of the 
statements, that, under some circumstances, a few 
hours may be sufficient for the development of the 
eruption. Generally, the skin begins to show some 
signs of inflammation by the end of forty-eight hours. 
That new efflorescences may continue to appear, after 
the first manifestations, for a much longer period, we 
have already seen. 

But how shall we explain some of the peculiar 
phenomena connected with the action of this poison, 
as recorded in my own case, for instance ? The first 
vesicle appeared on the second day following that of 
contact with the juice. From that time for twenty- 
two days these characteristic efflorescences continued 
to be occasionally developed, singly toward the last, 
and on parts of the hands more or less remote from 
one another. Where had the active principle, which 
on November 3 gave rise to the solitary vesicle on 
my left thumb at a distance of two inches from 
the single and only other eruption on that member, 
been since the contact on October 10 ? Had it been 
originally absorbed at that particular point, and been 
lying dormant for three weeks before sufficiently im- 



62 DERMATITIS VENENATA. 

pressing the tissues to recognize its presence by such 
excessive vitality of action ? or was the poison borne 
thither at that late period from some other focus of 
activity? or had the spot been freshly poisoned by 
contact with parts similarly affected ? Strange as it 
may seem, the first of the three suppositions is the 
least improbable, and must therefore, for want of bet- 
ter explanation, be accepted as the solution of this 
mysterious action. 

With regard to the latter point, that of contagion, a 
definite opinion may be expressed. The question is 
often asked, " Is ivy poisoning contagious ? Will con- 
tact with the eruption, or the fluid discharges, produce 
the disease upon other parts of the same person, or 
upon the skin of another individual ? " It is not at 
all improbable that a person who has been handling 
specimens of Rhus might, by immediately taking the 
hand of a person excessively sensitive to its action, 
and before the volatile principle had been dissipated, 
or washed away, or absorbed, convey the poison thus 
to the other, which would subsequently prove effect- 
ive. That would be transferring the poison, not the 
disease. Professor Maisch shows the possibility of 
such an event in the account of his experiments. It 
is in this way that the genitals are so often affected, no 
doubt, in being handled during micturition while out 
of doors or at night, and while the poison is still fresh 
upon the hands. There are no grounds for believing 
that, the poison once absorbed, or removed by washing 
or volatilization, the disease is in any way contagious. 
The freest handling of parts affected in all stages of 
the efflorescence fails to transfer the disease to the 
hands of another, and I believe surface contact with 



DERMATITIS VENENATA. 63 

other parts of the same individual entirely ineffectual 
in spreading the eruption after the lapse of twenty- 
four hours. To determine the possibility of such com- 
munication, I undertook the following experiment 
in connection with my own case. On October 14th 
both the vesicles upon my wrist, the one of twenty- 
four, the other of eight hours' duration, were opened, 
and their clear and colorless contents applied and 
scratched into the epidermis on the wrist of a gentle- 
man who is especially sensitive to the poison of Rhus 
toxicodendron, having suffered twice during the pres- 
ent summer, and many times and severely in past sea- 
sons, from contact with it. The result was wholly 
negative. Dr. Bigelow reports that Dr. Pierson inoc- 
ulated with the serum from vesicles on the second day 
in the case above referred to, and with the discharge 
from the later stage, but without effect. 

On Animals. — I have been unable to find a single 
instance on record of the poisonous action of Rhus on 
the lower animals. I have inquired of a great number 
of sportsmen with regard to their dogs, and published 
in the " Spirit of the Times," through the courtesy 
of its editor, a similar inquiry. There seems to be 
no reason why short-haired pointers, considering the 
necessarily frequent contact with poison ivy while 
hunting, should not sometimes exhibit the effects of 
its action, if their skins were at all susceptible. One 
gentleman, a physician, told me that his dog's eyes 
had been closed by swelling once or twice while hunt- 
ing where ivy abounded, which he attributed to its 
action, but he had never seen any eruption upon the 
skin at the time. 

The leaves of both species are found eaten by 



64 DERMATITIS VENENATA. 

worms, and spiders attach their webs to them. Dr. 
Bigelow, on the other hand, refers to an account, in 
the New York Medical Repository, of a swarm of bees 
alighting on the branches of Rhus venenata. The next 
day they were found dead, their bodies being black 
and swollen. He adds, that in spring their flowers are 
sought by numerous insects. On the other hand, I find 
it stated that insects never attack the Japanese tree. 

Treatment. — A great many remedies have been rec- 
ommended, in both medical and botanical books, for 
the treatment of persons poisoned by Rhus, while 
others of a " domestic " character are used in various 
parts of the country. Among the former, a solution 
of acetate of lead holds the most conspicuous place. 
Torrey, in his " Botany of New York," says one of the 
best applications is a solution of sugar of lead, after 
the use of saline cathartics. Dr. Bigelow (Medical 
Botany) thinks the application of acetate of lead as 
useful as any external palliative, and that it should 
be used as cold as possible. Solutions of sulphate of 
copper and of other metallic salts have also been 
recommended by physicians. Among the domestic 
remedies, vinegar, and solutions of saleratus and car- 
bonate of soda, are widely and highly esteemed. A 
decoction of Virginia snakeroot (Serpent aria) is also 
supposed to possess special power over the poison. 
In an old copy of Bigelow' s "Florula Bostoniensis," 
picked up in a second-hand bookstore, I find, in con- 
nection with Rhus toxicodendron j a marginal note by 
its former owners, stating that, if soft-soap be rubbed 
thoroughly into the hands after handling specimens, 
its poisonous action will be prevented. The following 



DERMATITIS VENENATA. 65 

list comprises most of the other articles recommended 
by writers in medical journals as " cures " for Rhus 
poisoning, many of which are stated to be " specific/' 
and to act "like magic." It is needless to give the 
detailed directions for their application. 

Grindelia robusta. Sassafras officinale. 

Comptonia asplenifolia. Atropa belladonna. 

Dulcamara berries (in cream). Solutions of 
Cephalanthus occidentalis. Bromine. 

Gelsemium sempervirens. Sulphate of zinc. 

Khamnus. Chlorate of potash.. 

Lactuca elongata. Chlorinated soda. 

Collinsonia Canadensis. Sulphite of sodium. 

Quercus alba (bark). Alum curd. 

Lindera benzoin. Turkish bath. 

It is always a suspicious element in therapeutics 
when remedies are recommended as specifics, and 
when the list of cures for any one disease is excep- 
tionally long. It is not strange, therefore, that we 
find even non-professional writers remarking that 
"the reputed remedies are more numerous than effi- 
cacious " (Torrey and Gray) ; and that an editorial in 
the Pacific Medical and Surgical Journal says with 
regard to several proposed specifics for the cure of 
poisoning by Rhus diver siloba : " The washing with 
these decoctions does more good than the various 
materials contained in them. In the early stages 
they may thus all be of benefit, but afterwards they 
exert little influence over the course of the inflam- 
mation. This is the reason why there are so many 
sure cures for Rhus poisoning.' ' x 

1 See the excellent editorial notes on the treatment of Rhus poisoning 
in the Journal of Cutaneous Medicine, June, 1886, by Dr. Morrow. 

5 



66 DERMATITIS VENENATA. 

It is evident from our knowledge of the nature of 
the poison and its effects, as above described, that two 
distinct questions are to be considered in connection 
with the treatment of Rhus poisoning, as in toxico- 
logical therapeutics generally : first, that of the neces- 
sity and selection of an antidote ; second, that of the 
proper management of the changes in the tissues of 
the skin. So far as I know, these are not sufficiently 
recognized by writers and practitioners, perhaps be- 
cause we were so long ignorant of the true chemical 
nature of the poison ; and the reputation which some 
of the above-mentioned remedies have, perhaps justly, 
acquired, rests upon their successful action in one or 
the other of these directions, according to the period 
in which they may have been used. Moreover, it 
should not be forgotten that the inflammatory process 
excited by the poison is generally self-limited in its 
duration. 

If contact with poison Rhus be known or suspected, 
the parts should be immediately washed or bathed for 
a considerable time with water, and care exercised 
that the hands, if they have touched the plant, are 
not applied to any part of the body until after such 
thorough soaking. 

Whether or not we should resort to an antidote 
must, of course, be determined by the length of time 
since the parts affected were in contact with the 
plant or its exhalations. As the poisonous principle 
is of a volatile character, it is questionable how much 
good can be done in this direction after the first day, 
or even during it, after the hands have been washed 
with simple water. How long the poison may retain 
its characteristic peculiarities after absorption by the 



DERMATITIS VENENATA. 67 

skin, and how readily our antidote may follow and 
penetrate to it, are also matters of uncertainty. As 
to the nature of the remedies to be used at this stage 
and for this purpose, there can be, of course, no longer 
any question. We have to deal with an acid, and the 
antidote for an acid is an alkali, — that is, provided 
the salts thus formed are not equally poisonous. In 
poisoning by oxalic acid, for instance, potash is not 
an antidote, because the combination formed is nearly 
as poisonous as the acid itself. Whether the salts 
formed with toxicodendric acid by ammonia, potash, 
and soda are likewise poisonous, Professor Maisch 
leaves us somewhat in doubt as the result of experi- 
ment, but speaking clinically he leads us to believe 
that they are not ; for he says that the application of 
solutions of ammonia seemed to be most effective in 
counteracting the action of the acid. This is consist- 
ent with the popular reputation of solutions of salera- 
tus and soda as remedies, and will explain the action 
of the soft-soap above mentioned. These are true 
antidotes, but they can be of benefit only from their 
chemical action, and in this way. In the later stages, 
or, in other words, against the subsequent inflamma- 
tory changes in the cutaneous tissues, they can do no 
good. The action of that most popular of all reme- 
dies in this affection, the solution of sugar of lead, 
is a mixed one, and seems to have been happily, 
though unwittingly, selected as an appropriate rem- 
edy in all stages. Toxicodendric acid precipitates 
from it an insoluble and therefore harmless salt, 
while its astringent action is well adapted in many 
cases to the relief of the inflammatory processes in 
the skin. 



68 DERMATITIS VENENATA. 

The treatment of the later stages of Rhus poisoning, 
that is, of the eruption it produces, need not be espe- 
cially considered ; for it is mainly that of the corre- 
sponding varieties of ordinary acute eczema. It is 
seldom that the physician is called upon before the 
inflammatory process is well developed, so that there 
generally remains for him only the selection of the 
applications appropriate to a simple eczema of the 
same stage. In the specific efficacy of any particular 
drug, internally or externally employed, I do not be- 
lieve. In the great majority of cases I have found 
black-wash — calomel 3J, lime-water Oj — by far the 
best application to the affected parts, used as an 
evaporating lotion upon thin and old linen or cotton 
cloth, for half an hour at a time, two or three times a 
day. I have used in connection with it, to moist or 
excoriated parts, a powder of oxide of zinc 3J, starch 3 j, 
or plasters of oxide of zinc or diachylon ointment, as 
in the management of ordinary eczema. In the black 
wash we have, possibly, three elements at work in 
our favor : first, the alkali as antidote, if it is of 
any avail at such periods ; second, the action of cold 
from evaporation upon the local hyperemia ; and, 
third, the so-called astringent effect of the mercurial 
powder upon the diseased tissues. Caution is neces- 
sary in its use, however, when extensive surfaces are 
affected, owing to the danger of absorption of the 
mercury. In such cases, therefore, and with dis- 
pensary patients, I generally employ the following 
wash : — 

ft. zinc. oxid. 3iv, acid, carbol. 3], aq. calcis Oj, m. 
This, after being shaken, is sopped over the affected 
parts freely and repeatedly throughout the day, and 



DERMATITIS VENENATA. 69 

by night as well, as often as the patient is wakened 
by the intense itching and burning which characterize 
the inflammation in its early stages. It may be 
applied over the whole surface of the body, and for 
any length of time, with safety, and is generally well 
borne in all phases of the dermatosis. I know no 
more reliable remedy for the relief of the patient's 
sufferings, and for checking and abbreviating the 
course of the inflammatory process. Yet, under the 
use of this or any applications, the lesions of an 
acute dermatitis of high grade, when once devel- 
oped, require a certain time for their necessary steps 
of involution, and must continue to occasion more 
or less disturbed sensation in the parts. Such tis- 
sue changes are physical, and cannot be made to 
disappear with the magical suddenness attributed 
to the action of many of the " cures " above enu- 
merated. 

I am acquainted with no internal remedies which 
exert any direct influence over the course of the 
affection. Saline cathartics may be used if they 
are required, and sometimes cooling drinks, as ace- 
tate of potash, if there be — which is rarely the 
case — any febrile disturbance of the economy. The 
diet in severe cases should be simple, and no hot 
or stimulating drinks allowed. No scratching or 
rubbing should be permitted, and old cotton or 
linen garments should be worn in contact with the 
inflamed skin. 

Doubtful Species. 

There are other species of Rhus in the United 
States, concerning the poisonous nature of which 



70 DERMATITIS VENENATA. 

much doubt still exists, even among botanical and 
medical authorities. 

Rhus pumila grows abundantly in the pine bar- 
rens of the Carolinas and Georgia. Chapman, in his 
Flora of the Southern States, describes it as "Low, 
procumbent ; branches and petioles tomentose ; leaf- 
lets 11-13, oval or oblong, acute, coarsely serrate, pale 
and tomentose beneath. Branches one foot high." 
Pursh says it is the most poisonous of all the species. 
Elliot, in his sketch of the botany of South Carolina 
and Georgia, says, on the authority of Mr. Lyon, that 
it is very poisonous. Loudon, in his Cyclopaedia, 
states that this Mr. Lyon, a collector, suffered se- 
verely after gathering the seeds. Dr. Porcher of 
Charleston kindly answers my inquiry, that he quotes 
the opinion of Pursh above given in his " Resources 
of Southern Fields and Forests/' but adds, " I can 
say nothing positive concerning it from personal ex- 
perience.' ' In Wood's Botany it is placed with the 
poisonous species, and the National Dispensatory gives 
it the same character. 

On the other hand, Curtis, in his " Shrubs of North 
Carolina," says, " Pursh has represented it as being 
very poisonous, but it is perfectly harmless." My 
friend, Dr. W. H. Geddings, of Aiken, was kind 
enough to address H. W. Ravenel, Esq., a distin- 
guished botanist of South Carolina, with regard to 
it, who writes : " I can say that Rhus pumila is not 
poisonous ; it belongs to the non-poisonous section 
of the genus." Lastly, Dr. Chapman in his valuable 
manual states that it is not poisonous. 

Rhus metobium. This is a tree growing in the 
West Indies and in Southern Florida, called coral 



DERMATITIS VENENATA. 71 

sumach or mountain manchineel. The National Dis- 
pensatory pronounces it poisonous, as does Nuttall in 
his work. Dr. Chapman, on the contrary, does not 
include it in the poisonous group of species. 

Semecarpus anacardium. Cashew Nut. 

Indian Marking-Nut. 

This tree is a native of Tropical America, but has 
been naturalized in Africa and the East Indies. It 
bears an edible nut, but its rind or mesocarp con- 
tains an oily liquid, which turns black on exposure 
to the air, and acts as a severe irritant upon the 
skin. Its active principle is a yellowish oil called 
cardol. 

According to the Dispensatory, the juice of the rind 
of the nut is almost caustic, and has been used for 
destroying corns, warts, and vegetations, and as an 
epispastic ; but the last application it considers to be 
very objectionable, because it is apt to be carried by 
the patient's fingers to the genitals and other parts, 
and to give rise to a very painful and persistent 
eczematous eruption. It states also that the liquid 
in the blisters has a similar property. 

Kev. Charles Kingsley, in "At Last," states that 
the fumes of the oil will blister the cook's face while 
roasting the nuts, if she hold it too near the fire. 

Dr. Taylor, of Guy's Hospital, reports (Medical 
Times and Gazette, Nov. 6, 1875) the following case 
illustrative of its action. A boy aged thirteen rubbed 
some of the juice upon the arm, May 9th. The part 
turned black upon drying, but produced no ill results 
except a little smarting for a week, when on the 16th 
the arm became red, and pimples appeared upon it. 



72 DERMATITIS VENENATA. 

At the same time his face became red and swollen, 
and the next day he came to the hospital. The left 
hand, forearm, and lower half of the upper arm were 
swollen, and of a bright red color, resembling erysip- 
elas. On the forearm where the juice was applied 
was an abrasion, and over the rest of the part were 
many vesicles of various sizes and shapes, mixed with 
minute pustules. There were a few efflorescences of 
a similar character on the right hand. The face pre- 
sented a similar inflammatory condition. There were 
redness and swelling of both eyes (the left being quite 
closed), upper lip, chin, and right cheek. On the chin 
was a yellow crust resembling that in eczema. There 
were patches of vesicles and redness also on the inner 
side of each thigh and lower part of the abdomen. 
The eruption caused considerable itching. The in- 
flammation reached its height on the 21st, and had 
nearly disappeared on the 31st, when he was dis- 
charged. A playmate who also applied the juice to 
himself at the same time was affected in a similar 
manner. 

It will be seen that the action of cardol very closely 
resembles that of Rhus. 

APOCYNACEJE. 

Nerium oleander. Oleander. 

This ornamental tree, a native of Palestine and the 
East, was formerly much cultivated in tubs, so as 
to be kept in-doors during the severe winters of our 
Northern States. 

Bigelow remarks that it is said to affect some per- 
sons in a similar manner to Rhus. 



DERMATITIS VENENATA. 73 

Loudon states that its leaves are acrid and poisonous. 

Figuier describes it as a destroyer of cutaneous ver- 
min, and a formidable poison. 

Van Hasselt states that the oil obtained from the 
leaves produces intense burning and itching when 
rubbed into the skin. 

The National Dispensatory also states that the 
essential oil irritates the skin. 

Piffard quotes Barton as ascribing to it a vesicat- 
ing property. 

ABAC EM. 

Arissema triphyllum. Indian Turnip. Dragon-root 

Jack-in-Pulpit. 

Bigelow states that every part of this widely dif- 
fused plant, especially the root, is violently acrid, and 
almost caustic. 

Piffard quotes authorities for the statement that 
the fresh leaves and root are rubefacient and vesicant. 

The National Dispensatory says that the juice of 
the fresh plant applied to the skin may produce 
vesication. 

A North Carolina dealer, who offers one thousand 
pounds of the root for sale, informs me that it produces 
intolerable itching and inflammation of the skin. 

It was a trick among the boys of my day to " stump " 
their playfellows to taste certain plants well known 
to the experienced. The favorite ordeal was a slice 
of a tuber of this showy plant. I remember that no 
amount of water would quench the fire it set going 
in the tongue for a long time after the briefest con- 
tact with it. 



74 DERMATITIS VENENATA. 

Its active principle is unknown. 

The Dispensatory states that the Ariscema dracon- 
tium, the Green Dragon, applied to a freshly blistered 
surface, augments its secretion. 

Symplocarpus fcetidus. Skunk Cabbage. 

A common plant in the New England, Middle, and 
Western States. 

Bigelow states that an acrid principle exists in the 
root, even when perfectly dry. 

Mr. Cheney, a dealer in native drugs, informs me 
that the root produces intolerable itching and inflam- 
mation of the skin. 

ARALIACEJE. 

Aralia spinosa. Angelica Tree. Prickly Elder. 

Southern Prickly-Ash. 

This large shrub, belonging to the Sarsaparilla 
genus, grows from Pennsylvania southwards, and is 
much used in " botanic " medicine. Mr. Cheney in- 
forms me that the green bark, when taken from the 
roots or small shrubs, acts as an irritant upon the 
hands of the collectors. 



ARTOCARPACEM. 

Antiaris toxicaria. Upas Tree. 

A native of Java. 

According to old accounts, this was the most deadly 
object of creation. It was told in traveller's tales 
that but a single tree of the kind existed in Java, and 



DERMATITIS VENENATA. 75 

that this was so poisonous that no other plant could 
live within a circuit of fifteen miles. No animal could 
live within this region of death, and birds flying over 
it perished and fell. Men approaching it from the 
leeward fell dead, and of one hundred persons con- 
demned to death who were employed to collect its 
juice only three survived the attempt. So much for 
fables. The facts are that the juice of the tree is 
the source of one of the most deadly arrow poisons, 
Upas antjar. 

Loudon states that when the trees are largely 
wounded or felled the effluvia produce cutaneous 
eruptions. 

Van Hasselt reports that among the Javanese a 
dermatitis toxica, an erysipelatous swelling resem- 
bling that of Rhus, is produced on contact with the 
tree. 

According to the Dispensatory, this poisonous prin- 
ciple is antiarin. 

The tree has been cultivated in botanic gardens, 
and would appear to be no more poisonous on contact 
than Rhus venenata. 

AURANTIACEJE. 

Citrus vulgaris. Bitter Orange. 

The bitter orange is completely naturalized in some 
portions of Florida, and its fruit is largely used in the 
manufacture of marmalade there and in some parts of 
Europe. Bazin describes the occurrence among the 
workmen engaged in peeling them in France, not only 
of some general symptoms in consequence of the satu- 
ration of the atmosphere with the oil, but of painful 



76 DERMATITIS VENENATA. 

erythema with swelling, and vesicular and pustular 
eruptions with itching. They affect the face and 
upper extremities, especially the left hand, which 
holds the fruit when being cut. The efflorescence 
is remarkable for its indefinite persistence in some 
cases, and for the intolerable suffering it sometimes 
causes. M. Imbert-Gourbeyre, who describes the af- 
fection (Moniteur des Hop., 1850, p. 78), likens the 
action of the volatile principle of the orange to that 
of camphor. 

Our Dispensatory states that persons employed hi 
manufacturing the oil of orange peel suffer greatly 
from erythematous, papular, and vesicular eruptions 
of the skin, especially of the hands and face. The oil 
contains a hydrocarbol called hesperidene, and some 
other undetermined elements. 

Inquiry among the large orange growers of South- 
ern California fails to discover the occurrence of irri- 
tation of the skins of thosg who handle the fruit ; but 
little marmalade is made there. 

BERBERIDA CUJE. 

Podophyllum peltatum. May Apple. Mandrake. 

This is a common plant in the Middle and Western 
States, and grows sparsely north and south of this 
belt. Gray describes the leaves and root as drastic 
and poisonous, and Wood speaks of it as a rather 
poisonous herb. It is largely used in medicine. The 
trade circular of one collector of our native drugs in 
North Carolina reports six thousand pounds in stock. 

Bigelow quotes Dr. Burgon as to its action. " I was 
employed one afternoon," he says, "in a close room 



DERMATITIS VENENATA. 77 

in powdering the Bad. podophylli, which by the next 
morning occasioned a most violent inflammation of 
my right eye and eyelid ; it yielded, however, to the 
antiphlogistic regimen in eight or ten days." 

The Dispensatory states that workmen employed in 
pulverizing the root find it extremely irritating to 
eyes, nose, mouth, and skin; and a large wholesale 
dealer in vegetable drugs informs me that the powder 
of the root often poisons the workmen, especially their 
eyelids. 

Mr. Lloyd writes : " Our employees experience great 
trouble in working this, owing to the irritating action 
on the skin. We have in numerous instances had our 
men cease work for several days owing to its action, 
which causes very painful inflammation of the skin, 
especially of the eyes." 

BIGNOmACE^. 

Catalpa bignonioides. The Catalpa. Indian Bean. 

This highly ornamental tree is a native of our 
Southern States, but has long been cultivated over 
the whole country, for the beauty of its bloom, and 
lately for its valuable timber. Its reputation is gen- 
erally good, but in exceptional cases it may act as a 
poison upon man. 

The National Dispensatory states that the emana- 
tions of the tree are reported to be poisonous. 

I am informed by a large dealer in our native me- 
dicinal plants that the flowers are irritant to many 
persons, producing reddening of the skin and mucous 
membrane. 



78 DERMATITIS VENENATA. 

BORRAaiNACEM. 

Borago officinalis. Borage. 

This plant, a native of Europe, is cultivated in our 
gardens. It is covered in all parts with short bristly 
hairs. It is used as a salad, and finds a place in our 
Dispensatory. 

Mr. Cheney, a large dealer in vegetable drugs, in- 
forms me that it is irritant to the hands, like cowhage, 
but in less degree. 

C ACT AC EM. 

Cactus grandiflorus. Night-blooming Cereus. 

According to the Dispensatory, this plant, a native 
of Tropical America, and cultivated amongst us for its 
showy and evanescent bloom, contains an extremely 
acrid juice, which is capable of producing vesicles and 
pustules on the skin. 

Piffard also states that it may cause pruritus, 
excoriations, and pustules. 

I have heard of no instances of disturbance of the 
skin produced by those handling it ; but as its pop- 
ular reputation is good, the source of such possible 
accidents may have been overlooked. 

COMPOSITE. 

Anacyclus pyrethrum. Pellitory. 

This is a plant resembling chamomile, growing in 
Africa, and its root, which is used in medicine, is 
described by the Dispensatory as a powerful irritant 
and rubefacient upon the skin. 



DERMATITIS VENENATA. 79 

Pyreihrum roseum, P. cameum, and P. cineraricefo- 
lium are allied plants, and their pulverized flowers, the 
so-called insect-powders, so destructive of insect life, 
have been known to produce some irritation of the 
skin when scattered over sheets to destroy bed ver- 
min. This statement I make on hearsay evidence, as 
I have met with no such results of their action. 

Arnica montana. Arnica. 

The following account of the action of arnica upon 
the skin was published eleven years ago, at a time 
when scarcely anything had been written upon the 
subject, and when it was regarded as one of the 
most valuable and harmless of domestic remedies for 
external use. 

I have seen several cases of dermatitis caused by its 
action since ; but they presented no features which are 
not sufficiently noted in the description then given, 
which I reproduce with but few changes. Within the 
last few years several articles have appeared in med- 
ical literature upon this property of the plant, # and 
its character should now be well understood, at least 
by the medical profession. 

Case I. — A gentleman, sixty-five years of age, in 
descending the stairs to mount his horse for a ride, 
slipped and scraped the lower part of his back. A 
handkerchief dipped in tincture of arnica was imme- 
diately applied to the bruised skin of the buttocks and 
worn in contact with the part during the ride, which 
was not given up on account of the injury. Before 
his return a good deal of itching was felt in the back, 

* The latest is by Dr. Paul de Molenes, Annates de Derm, el de Syph., 
Fevrier, 1886. 



80 DERMATITIS VENENATA. 

which caused the parts to be rubbed vigorously. On 
examination after reaching home, the skin was found 
to be already greatly congested, and the irritation of 
the parts increased a great deal during the day and 
night. On the next day I was called to see him. The 
skin of the back, nearly to the shoulders, was in a 
state of active hyperemia, and already covered with 
innumerable papules. The inflammatory process ex- 
tended rapidly downwards nearly to the knees, and 
forwards upon the abdomen and genitals. In a few 
days these parts presented all the characteristic ap- 
pearances of acute eczema in its various stages of 
progression : general hypersemia, papules, vesicles, ex- 
coriated and exuding surfaces, and crusts. The sub- 
jective symptoms were intense itching, stinging, and 
burning in the parts. Scarcely any clothing could be 
borne in contact with the skin by day, and sleep was 
for a few nights almost impossible, but the system 
generally was only slightly disturbed. The course of 
the affection need not, however, be given in detail, as 
it did not vary in any important particulars from that 
of an ordinary acute eczema of high grade and short 
duration ; the process reaching (under treatment) its 
height within a week, and rapidly disappearing with 
the usual retrogressive manifestations. 

Case II. — A gentleman, sixty years old, applied to 
his right arm above the elbow a fomentation of tinc- 
ture of arnica on two successive days, on account of a 
so-called rheumatic pain in the limb. The part be- 
came generally reddened and swollen in a few days, 
and ten days after the applications were made he con- 
sulted me. The arm from the elbow to the shoulder 
at that time was considerably swollen, of a vivid red- 



DERMATITIS VENENATA. 81 

ness, and covered over the lower half of this district 
with a very thick eruption of papules, many of which 
were already partially converted into vesicles. Great 
itching and burning were felt in the part, which grad- 
ually ceased as the inflammation subsided. The efflo- 
rescence under treatment did not progress beyond the 
vesicular stage, and the skin returned to its normal 
state in ten or fourteen days subsequently. 

Case III. — A gentleman, aged fifty-two years, was 
thrown from his carriage and sprained his knee. 
With the consent of his family physician, he dressed 
the part with fomentations of tincture of arnica and 
water. After two days' use of these, the skin over the 
knee became so red that the physician advised him 
not to apply them again. The redness extended down 
the leg nearly to the ankle, and upon this surface 
there was developed in a few days a general eruption 
of papules. A similar process, but of less severity, 
ensued a day or two later upon the inner surface of 
the corresponding parts of the other leg, which were 
more or less in contact with the fomentations. The 
efflorescence upon the legs did not pass into the vesic- 
ular stage generally, but remained at its height for a 
week, and then very gradually subsided under treat- 
ment. Three days after the use of the fomentations, 
an inflammation of the skin of the face also began, 
which increased in severity until I saw him, one week 
after the injury. His whole face was then very much 
swollen, of a deep red color, and covered with papules 
and vesicles towards its periphery, whilst upon the 
central portions there was a very free exudation of 
serum from many excoriated points, which in parts 
had already stiffened into crusts. The vesicles and 

6 



82 DERMATITIS VENENATA. 

papules on the forehead were arranged in prominent 
and isolated clusters of two or three individuals in 
each. The whole had an artificial look, and strongly 
resembled in appearance a severe case of ivy poisoning. 
The subjective symptoms were mainly intense itching 
with slight burning; and considerable suffering was 
thereby occasioned for several days. After two days' 
treatment, the amount of free exudation was largely 
reduced, and no new efflorescence appeared. The 
swelling and redness were still considerable on the 
fourteenth day after the beginning of the inflam- 
mation, but were rapidly diminishing, and at the 
end of the month the skin was again in its natural 
state. 

The nature and cause of the affection of the skin in 
these cases cannot, I think, be misinterpreted. In all 
of them we have an acute inflammatory process, con- 
fined to the upper dermal layers, and manifesting 
itself, according to the stage reached, by the follow- 
ing appearances : hyperemia, papules, vesicles, exco- 
riations, crusts, and scales, in regular sequence. The 
local sensations were intense itching and some de- 
gree of burning in the parts affected. There was no 
constitutional disturbance. In course, character, and 
sequence of the lesions in their development and retro- 
gression, in the intensity of the subjective and absence 
of constitutional symptoms, the type of the affection 
is unmistakably that of acute eczema. It may be that 
cases occur in which the inflammation extends so 
deeply, and reaches so high a degree, as to indicate 
the existence of a deeper dermatitis, but I have never 
seen them. 

The cause was also plainly manifest. The inflam- 



DERMATITIS VENENATA. 83 

mation followed in all the cases the application of 
tincture of arnica to the skin as a fomentation. In 
one of the instances, the first, the epidermis may have 
been slightly broken ; but in the others the skin of the 
parts was whole and healthy at the time of the appli- 
cations. The inflammation began to show itself after 
intervals varying from a few hours to several days, 
and was confined to the part to which the application 
was made, or extended from this as a centre. In the 
last case the disease was developed also upon the other 
knee and upon the face, but by direct contact, never- 
theless, with the exciting cause, for the right knee was 
in contact with the left during the nights that the 
fomentations were applied to the latter, and the face 
was frequently rubbed (a constant habit of the patient) 
with the hands while applying the fomentation. That 
the hands were not likewise affected may be accounted 
for by the greater resistance to absorption offered by 
the thickened epidermis of the palms. 

These three cases will serve, as well as more which 
might be presented, as typical illustrations of the ac- 
tion of arnica at times upon the skin. The affection, 
as will be seen, follows a very regular course in the 
character, distribution, and duration of its lesions, 
differing widely in some of these respects from the 
wayward manifestations so peculiar to the action of 
Rhus. Like the latter, arnica must therefore be re- 
garded as an irritant poison when applied to the skin 
of some persons, but of less intensity, and probably of 
less certainty in its action than Rhus. With regard to 
this latter point, the proportionate frequency of poi- 
soning after its external use, T do not know that we 
can form any judgment. There can be no doubt that 



84 DERMATITIS VENENATA. 

tincture of arnica is very often used in the same way 
as in the cases above given. It has long enjoyed an 
exceptionally permanent reputation, and almost mirac- 
ulous healing powers have been attributed to it. Oes- 
terlen says that " its reputation dates from the times 
when magicians carried on their hocus-pocus with it ; 
from these it passed into the hands of quacks, and 
finally to physicians/ ' There is scarcely a symptom 
of disease which, it was at one time thought in Eu- 
rope, its internal administration could not successfully 
meet. 

The physiological action of both the root and the 
flowers of arnica is said to be irritant, large doses pro- 
ducing vomiting and diarrhoea, inflammation of the 
stomach and bowels, headache, and dizziness. Its 
properties reside in an acrid resin and volatile oil. 
Our officinal preparations are a tincture, an alcoholic 
extract, and a plaster. That tincture of arnica has 
retained for centuries its great reputation as an appli- 
cation in bruises and sprains, and remains to this day 
perhaps the most popular remedy for such purposes, 
it may thank the alcohol associated with it, for this 
beyond doubt is the only active agent in such appli- 
cations. 

I am informed by one of the largest dealers in drugs 
in this city that their house sells between two and three 
thousand pounds of arnica flowers yearly, one half of 
which he thinks is used in veterinary surgery. 

If, then, it is used so extensively, why are not cases 
of poisoning by it of more common occurrence? I 
believe that they do occur not infrequently, but that 
they are not recognized. The appearances which fol- 
low its use are no doubt often mistaken for the im- 



DERMATITIS VENENATA. 85 

mediate effect, or the sequelae, of the injury or other 
trouble for which it was applied. Even the physician, 
there can be little doubt, often fails to recognize the 
artificial nature of the eczema he is called to treat, 
and to connect it with the prior application of arnica 
to the skin. The almost universal belief in its harm- 
lessness, too, would prevent in most cases the patient 
from communicating to the physician the fact of its 
use before the appearance of the disease. It is not to 
be wondered at, however, that physicians are so little 
acquainted with these poisonous properties, when we 
see how little mention is made of them in medical 
literature. The works on materia medica that I have 
at hand give it a more or less feeble commendation, 
but make no allusion to its injurious action upon the 
skin. Very few of the works on toxicology place 
arnica among the poisons, and Yan Hasselt, 1 who gives 
the fullest account of its injurious properties when ad- 
ministered internally, says nothing of its action upon 
the skin. Neither do I recall any reports in medical 
journals of cases of such affection. In works on der- 
matology, even, scarcely any mention is made of the 
subject. In a long list of substances enumerated as 
capable of producing eczema, in his chapter on this 
disease, Hebra includes arnica without special men- 
tion; but in his chapter on erythema nodosum he 
says : " Some medical men, however, suppose that 
the tincture of arnica is a perfectly harmless remedy 
in erythema nodosum, and in similar affections. But 
I would give a friendly warning to those who advo- 
cate its use ; unless, indeed, they propose to employ it 
homoeopathically and in infinitesimal doses. In the 

1 Handbuch der Giftlehre. 



86 DERMATITIS VENENATA. 

proportion of a drop of the tincture to a pail of water, 
this substance may certainly be applied without any 
risk of doing harm. But I have in practice had abun- 
dant occasion to observe that the tincture of arnica, 
even when much diluted, acts most injuriously upon 
the skin of some persons. I have frequently seen 
eczema or dermatitis excited by the assiduous appli- 
cation of lotions containing this drug, in the treat- 
ment of slight bruises or sprains." l Fox, in his brief 
remarks on medicinal rashes, says : " Arnica may 
produce erythema and swelling of the part to which 
it is applied, or it may excite a real eczema." 2 

It is to warn physicians who may be ignorant of 
these properties belonging to it, and that through 
them the public may be more generally informed con- 
cerning the dangerous character of one of the most 
popular and useless among domestic external reme- 
dies, that I have thus brought the subject before the 
profession. 

Piffard in his remarks upon this action of the plant 
suggests that, as all the cases which had fallen under 
his notice were produced by the use of the tincture of 
the flowers, it may be due to the larvae of an insect, 
Atherix maculatus, which infests the flowers. 

The National Dispensatory, on the other hand, 
states that the root is irritant as well as the blossom, 
and a large dealer in vegetable drugs states that the 
root is largely used as well as the latter, and that 
he disbelieves in the animal theory of its irritating 
property. 

Oesterlen also states that the root is irritant. 

1 Sydenham Translation, vol. i. p. 291. 

2 Skin Diseases, London, 1873. 



DERMATITIS VENENATA. 87 

The Dispensatory states that the active principle 
is uncertain, but that the plant contains formic and 
angelic acids and a volatile oil. 

Prof. Goodale of Cambridge writes : " Arnica mon- 
tana does not grow in the United States. All of our 
species, which are many, have more or less of its res- 
inous character, but we have not known that any of 
them are poisonous to touch." 

So far as I have been able to learn, none of them 
have been used for medicinal purposes. 

Bidens frondosa. Beggar-ticks. 

We have several species of burr-marigold growing 
in the United States, provided with a pappus of rough 
awns, which adhere to the passer-by in a troublesome 
manner. 

I am informed by Mr. Cheney that this plant causes 
itching on handling. 

Erigeron Canadense. Fleabane. JSbrseweed. 

This species of a very common weed in all parts of 
North America contains a volatile oil, and is the only 
one of the genus to which irritating properties have 
been attributed. 

Mr. Cheney informs me that the fresh plant will 
cause irritation upon the skin of many persons after 
handling it. 

Lappa officinalis. Burdock. 

A native of Europe, but a common weed in most 
parts of the United States. 

In the country burdock leaves are sometimes ap- 



88 DERMATITIS VENENATA. 

plied to the skin for the rubefacient action which their 
rough surface produces. 

I am informed by a wholesale dealer in vegetable 
drugs, that parts of the burrs mixed with the seeds are 
as bad to handle as cowhage, so that workmen always 
get to windward of them when packing them. 

Leucanthenmm vulgare. Ox-eye Daisy, White-weed. 

I have known one instance of poisoning by this most 
common weed, naturalized from Europe in all parts of 
the country. A papular and vesicular inflammation 
was produced upon the lateral surfaces of the fingers 
by plucking carelessly some of the flowers. This per- 
son, a physician, has recently assured me that on one 
or more occasions since the occurrence above noted 
he has experienced a similar result on handling the 
flowers. 1 

I have also in other instances of acute dermatitis of 
mild degree, occurring during the flowering season of 
this plant, suspected that it might be the cause of the 
irritation, but have been unable to obtain positive 
evidence of such action on its part. 

Maruta Cotula. Mayweed. Wild Chamomile. 

The leaves of this common roadside weed, a native 
of Europe, are used, according to the Dispensatory, as 
an external application, and its juice is described as 
capable of blistering the skin. 

In the days of my boyhood it was commonly used 
as the steadying tassel at the end of the kite tail when 
additional balancing was necessary, and the sharp, 
acrid nature of the juice was well known. 

1 See Boston Medical and Surgical Journal, vol. cxvi. p. 227. 



DERMATITIS VENENATA. 89 

Solidago. Golden-rod. 

There are some seventy or more species, not to men- 
tion varieties, of Solidago in the United States, only one 
of which, 8. odora, is used in medicine. I have long 
had golden-rod on my list of suspected plants, for in 
several instances I have seen a mild dermatitis, develop 
upon the hands of those who have gathered it, and 
who have assured me that this was the only flower 
they handled ; but as one must go into the fields to 
gather wild-flowers, and opportunity is so favorable for 
touching ignorantly or inadvertently the ubiquitous 
Rhus or other possibly poisonous plants under such 
circumstances, I have hesitated to attribute such irri- 
tative action positively to any of our golden-rods. I 
was surprised, on consulting the Dispensatory, to find 
the statement that 8. odora contains a volatile oil, and 
is irritant and rubefacient. 

Xanthium strumarium. Cocklebur. Cloibur. 

Sea Burdock. 

This rough plant, growing in New England and 
the Middle States, according to Mr. Cheney, causes 
itching on account of the hairs or dust with which it 
is covered. 

CONIFERM 

Abies Canadensis. Hemlock Spruced 

Abies excelsa. Norway Spruce. 

The resins which exude from these trees under the 
names, respectively, of Canada pitch and Burgundy 
pitch, act alike upon the skin when applied to it 
in the form of a plaster. When worn for varying 



90 DERMATITIS VENENATA. 

periods, it causes redness, itching, papules, and on 
delicate skins even pustules and superficial ulcers. 

According to Piffard, it produces an eczematous 
eruption. 

Junipems Virginiana. Red Cedar. Savin. 

Junipems Sabina. Savin. 

Both these species of American juniper, the former 
found throughout the United States, the latter in its 
northern parts, possess irritating properties when ap- 
plied to the excoriated skin at least. The leaves of 
both are used, after being made into an ointment, to 
promote or sustain the discharge from blistered sur- 
faces. The latter was formerly used in the treatment 
of alopecia. 

According to Piffard, Juniperus communis, which 
inhabits the northern parts of North America, also 
produces a slight redness, and sometimes even vesi- 
cation. 

Thuja occidentalis. Arbor Vitce. 

The National Dispensatory states that the fresh 
leaves sometimes irritate the skin, like savin. It 
grows from Pennsylvania northward. 

CRASSULACEJE. 

Sedum Acre. Mossy Stonecrop. 

English Moss. Eouseleeh. 

This little plant, a native of Europe, is much used 
as an edging for beds in the flower garden, and may 
often have been the cause of mischief upon the hands 
of fair gardeners, the nature of which has not been 
suspected. 



DERMATITIS VENENATA. 91 

Wood states that the whole plant abounds in an 
acrid, biting juice. Oesterlen says that it is sharply 
irritative upon the skin. 

The National Dispensatory states that the juice is 
capable of blistering the skin, and that it is used upon 
corns and warts to soften them, and upon swollen 
glands as a resolvent. 

Mr. Cheney, a wholesale dealer in vegetable drugs, 
informs me that the juice of the green plant is poison- 
ous to the skin of many persons. 

CRUCIFEIUE. 

Lepidium sativum. Pepper grass. 

Nasturtium Armoracia. Horseradish. 

Sinapis alba, Sinapis nigra. Mustard. 

Sisymbrium officinale. Hedge Mustard. 

These, and several other members of this family, 
are typical rubefacients. The acrid principle pro- 
ducing this effect has been called sinalbin in mustard, 
and many of the Cruciferae contain it. 

The action of the sinapism is well known. In a few 
minutes after its application the skin begins to feel 
warm, and by the end of a half-hour, if the patient 
bear it so long, this sensation has increased to an in- 
tolerable burning. The changes in the cutaneous tis- 
sues are, within a few minutes, a considerable degree of 
hypersemia, which after a time increases to an intense 
redness, which persists for a day or two, and often 
leaves behind it a persistent pigmentation, at times of 
a dark brown color, to mark the seat of the sinapism. 
On this account one should never be applied upon the 
upper chest, or other part of a woman which the dress 



92 DERMATITIS VENENATA. 

will not always conceal. If the action be continued 
beyond its legitimate rubefacient effect, a period which 
varies greatly in persons, it may produce vesication, or 
even deep suppuration, effects at times very intracta- 
ble under treatment. It is stated that the addition 
of vinegar to a mustard poultice greatly lessens its 
activity. 

The volatile oil of mustard is a powerful irritant 
and caustic. 

Nasturtium and Sisymbrium, above mentioned, are 
both capable of blistering the skin, if applied to it. 

CUCURBIT ACEM. 
Bryonia alba. Tetterberry. Wild Hops. 

This plant, of which we have but one indigenous 
representative, is regarded with much favor by the 
" botanic " practitioner. The Tayuya-root, recently 
tried as a remedy for syphilis, belongs to the genus. 

The Dispensatory states that the fresh plant applied 
to the skin produces vesication. 

Piffard states that the fresh plant applied to the 
skin produces redness, and, if left on for some time, a 
pustular eruption. 

DROSERACE^E. 

Drosera rotundifolia. Sundew. 

According to Loudon, the juice of this interesting 
carnivorous plant, common in the Northern parts of 
the United States, is acrid, and removes warts, corns, 
freckles, and sunburn. 

Piffard attributes vesicating properties to it. 



DERMATITIS VENENATA. 93 

EBICACEjE. 

Chunaphila umbellata. Pipsissewa. Prince's Pine. 

Wintergreen. 

Inhabits the Northern United States and Canada. 

The National Dispensatory is my authority for the 
statement that the fresh bruised leaves applied to the 
skin cause redness, and even vesication. 

Bigelow states that it acts as a topical stimulant, and 
when long continued not ^infrequently vesicates. 

Oxydendrum arboreum The Andromeda Tree. 

(Andromeda arbor ea, Z.). Elkwood. Sorrel Tree. 

The bark and leaves of this tree, which grows in the 
Middle and Southern States, are used in " botanic " 
medicine. The latter have an acid taste. It is put 
down in the Dispensatory as allied to our poisonous 
Kalmias. 

Mr. Cheney informs me that it is an acrid poison 
when handled. 

EUPHORBIA CEJEJ. 

Buxus sempervirens, L. Box. 

This old-fashioned garden border plant, a native of 
Europe, was an object of suspicion in the classic age, 
for Loudon states that Corsican honey was supposed to 
owe its infamy to the bees feeding on the box. It is 
collected for its supposed medicinal virtues " in the 
treatment of syphilis, epilepsy, and hysteria/ ' and 
Mr. Cheney informs me that the juice of the plant 
will cause irritation and intense itching to many. 



94 DERMATITIS VENENATA. 

Croton tiglmm. 

This tree, from the seeds of which croton oil (oleum 
tiglii) is obtained, is a native of the East Indies. 

The oil has long been employed in the East as an 
external irritant and purgative. It was formerly 
largely used to produce a " counter irritation " upon 
the skin in diseases of the chest, and was pricked into 
the skin in the process called " Baunscheitismus." 
Lately its external emplbyment in medicine has greatly 
fallen into disuse, but it still plays an important part 
in some popular unofficinal liniments. According to 
the Dispensatory five thousand one hundred pounds of 
the oil were imported into the United States in 1878, 
and in 1883 only three hundred and eight pounds. 
Its active irritative principle has been attributed to 
various substances obtained from it, but it is not 
definitely known. 

When gently rubbed into the skin, it produces after 
a short time a considerable degree of itching, redness, 
and burning, and within a few hours small red papules 
may develop. All these phenomena, representing the 
lowest grade of inflammation, may wholly disappear in 
the course of twenty-four or thirty-six hours. If the 
oil be applied more freely, or rubbed repeatedly into 
the same area, the subjective symptoms are intensified, 
and the papules are more abundant, thickly crowded, 
acuminated or sharply rounded, and are often sur- 
rounded with a bright red halo. After a time the tips 
of the efflorescence become opaque by the effusion of 
serum within the epidermal layers, and the vesicular 
stage of inflammation is established. By the second 
day, if the quantity of oil used has been sufficient, the 
eruption has become distinctly pustular, and for three 



DERMATITIS VENENATA. 95 

or four days new lesions may appear and undergo 
similar metamorphoses. They may become confluent, 
discharge their coverings, and form large crusts, or 
their contents may be absorbed during involution with- 
out rupturing. Generally the pustules become flat- 
tened or umbilicated, but are never as large as those 
produced by the application of tartar emetic. The 
skin remains red for a considerable time after the 
disappearance of the efflorescence, according to the in- 
tensity of the preceding inflammation. Scars are a 
frequent sequel of the process, but their formation 
seems to be to some extent an individuality of the 
skin. They are often merely punctate, are generally 
crowded, and rarely prominent. The seat of the in- 
flammatory process is sometimes the epidermal layers 
alone, in which case no cicatrices result ; but when the 
oil has been freely or thoroughly applied, it affects the 
papillary layer and subjacent portions of the corium. 
Sometimes it follows the glandular structures down- 
wards to the deepest parts of the cutis, forming furun- 
cular-like lesions. 

Euphorbia. 

More than one hundred species of Euphorbia, or 
spurge, grow in the United States, either indigenous 
or immigrants from Europe. Of every species Loudon 
says the juice is so acrid as to corrode and ulcerate 
the body wherever applied ; and of E. resi?iifera, from 
which the officinal euphorbium is obtained, Pliny and 
Dioscorides, according to the Dispensatory, describe 
the method of collecting juice, so as to prevent irri- 
tation of the hands and face. This substance is used 
as a plaster to prolong suppuration. 



96 DERMATITIS VENENATA. 

Van Hasselt states that the juice of several species 
is used by quacks to remove warts, freckles, as depila- 
tory, etc. ; and that the application of the juice, powder, 
and extract produces not only erysipelatous, pustular, 
and phlegmonous inflammation, but even gangrene. 
In one case mentioned the whole abdominal wall 
became the seat of gangrene. 

Of our native species, Bigelow says that the juice 
of several was used in his day to destroy warts ; and 
Gray describes them all as containing an acrid, poison- 
ous juice. The most active of them are E. corollata, 
E. ipecacuanha, and E. lathyris. The first of these, 
commonly called snake-milk, according to Bigelow has 
been used for blistering purposes, and the Dispensatory 
states that the bruised root will vesicate the skin. 

Mr. Cheney informs me that the juice of E. ipecacu- 
anhas is quite troublesome to many who collect and 
handle it ; and Bazin states that the dust of E. la- 
ihyris, growing both in Europe and in this country, 
causes redness, painful swelling, and vesicles upon the 
workmen employed in handling it. 

Hippomane mancinella. Manchineel. 

This large family of Euphorbiaceae contains some of 
the most poisonous plants. One of the most virulent 
is the manchineel, a small tree, bearing fruit resem- 
bling an apple, which grows in Southern Florida. 

Loudon states that it abounds in a white milk 
highly poisonous, and so very caustic that a single 
drop placed upon the skin instantly causes the sensa- 
tion of a hot iron, and in a short space of time raises 
a blister. It is a common belief that to sleep under it 
causes death. Whole woods on the sea-coast of Mar- 



DERMATITIS VENENATA. 97 

tinique have been burned in order to clear the coun- 
try of such a dangerous pest. The fruit is highly 
poisonous. 

The following is an extract from " West India 
Sketches " : " The branches contain a milky juice 
which will certainly blister the skin, and it has been 
a common trick among the negroes to apply it to their 
backs in order to excite the compassion of those who 
might mistake it for the effects of beating." 

Kingsley, in his charming " At Last," writes of it : 
" We learnt to distinguish the poisonous manchineel, 
and were thankful in serious earnest that we had hap- 
pily plucked none the night before, when we were 
snatching at every new leaf ; for its milky juice by 
mere dropping on the skin burns like the poisoned 
tunic of Nessus, and will even, when the head is 
injured by it, cause blindness and death." 

Hura crepitans. Sand-box. 

A large tree, native of Central America and the West 
Indies. Hura Brasiliensis has similar properties. 

Its abundant milky juice contains a very acrid vola- 
tile principle. It has been used in Brazil in the treat- 
ment of leprosy. A decoction applied to the skin 
causes irritation and vesication. 

According to Piffard, it produces severe swelling 
of the face. 

Jatropha urens. 

Jatropha urens, L., var. stimulosa, (Cnidoscolus stim- 
ulosus, Pohl,) is a plant growing from Virginia south- 
ward in sandy soil along the coast. It is abundantly 

7 



98 DERMATITIS VENENATA. 

supplied with stinging bristles, and is well named 
" Tread-softly." 

Stillingia sylvatica, L. Queen's-root. 

The Dispensatory states that the root is acrid. Pif- 
fard quotes Frost as stating that it causes smarting 
and irritation, and Mr. Cheney informs me that the 
juice from the green root will inflame, and produce 
swelling of the hands and joints. It grows in the 
Southern States. 

FUNQL 

Ustilago hypodites. 

In the Annates de Derm, et de Syph., November, 
1885, there is an abstract of an article published by 
Gerbaud on an affection among the workers in reeds 
in Provence, due to the action of this fungus, which is 
parasitic upon Arundo donax. 

The inflammation affects almost exclusively the face 
and genitals. It begins upon the former with a vio- 
lent itching in about twenty-four hours after contact 
with the reeds, which is followed by a uniform redness, 
especially marked about the orifices, and swelling of 
the eyelids. The appearance of the patient strongly 
resembles that of erysipelas. Later small vesicles de- 
velop, terminating in persistent excoriations. 

Upon the male genitals it begins also with itching, 
followed by general swelling, with intense redness of 
the scrotum, and later by vesicles filled with a yellow 
serum, terminating in persistent and very painful ero- 
sions. The penis is sometimes affected, producing an 
inflammatory phimosis. 



DERMATITIS VENENATA. 99 

Delicate skins are most easily affected, and a moist 
condition favors the action of the parasite. Similar 
effects were produced upon the skin of the rabbit, by 
applying to it after being shaved some of the fungus 
removed from the reeds. 1 

After reading the above, I wrote to Prof. W. G. 
Farlow of Cambridge, our authority in cryptogamic 
botany, with regard to the occurrence of this species 
in America, and received the following reply : " Your 
information about the poisonous character of Ustilago 
hypodites is something quite new to me. I do not 
know of any reference to the subject in botanical 
books. The spores of Ustilaginece are known to be at 
times irritants when they reach the air-passages, but 
they are not poisonous to handle. U. hypodites, a 
species whose characters are not very well marked, I 
may say, has been found in two places in this country. 
I found it at Wood's Holl, Mass., on Phragmites (a 
reed). It was found by Curtis in North Carolina on 
Arundinaria, the cane, and what is probably the same 
species occurs in Iowa on a species of Stipa. The fun- 
gus may be much more common in this country than 
is now supposed, as few persons have collected fungi 
of this order." 

Ustilago maydis, the corn-smut, grows upon our 
maize, and U. segetum attacks several of our grains, 
wheat, oats, barley, and our grasses ; but I have never 
heard of their producing any irritative action upon 
the skin. 

1 See also a description of other cases in Bazin, p. 67. 



100 DERMATITIS VENENATA. 

IRIDACEJE. 
Iris florentina. Orris-root. 

The root of this European flag seems to possess 
slightly acrid properties similar to our own Iris ver- 
sicolor. It has been used to make " issue peas/' and 
according to Piffard it may produce eczematoid and 
urticarial eruptions. 

LEGUMINOSM. 
Andira Araroba. Goa Powder. 

This tree grows abundantly in the forests near 
Bahia, Brazil, and contains in the large cavities which 
traverse the wood parallel with the trunk a powder of 
a light yellow color. This is obtained by cutting the 
tree down, splitting open the trunk, and scraping it 
out from the clefts. The workmen engaged in this 
occupation are obliged to protect their faces and air- 
passages against the irritating action of the dust. 
From this powder is extracted a crystalline substance, 
called at first and erroneously chrysophanic acid, now 
known in our materia medica as chrysarobinum. The 
action upon the skin of the Goa powder, which was 
first used in medicine, and of this extracted principle, 
is the same, differing only in intensity. 

The irritative properties of both are considerable 
upon many persons. Used first as an application for 
.the cure of ringworm, tinea trichophytina, later in 
psoriasis, and since then tried in the local treatment 
of many cutaneous affections, it has been found that, 
in addition to their power of staining the skin of a 
red, purple, or brownish color, they often produce such 
a degree of dermatitis that their use must be discon- 



DERMATITIS VENENATA. 101 

tinued. There is developed a marked degree of ery- 
thema (not to be confounded with the pigmentation), 
much oedema, especially about the face, and subse- 
quently desquamation ; also much burning. These 
results are so likely to follow its use upon the scalp 
or face, that its application to the head is scarcely 
justifiable. 

It may be most safely employed by so applying it 
that its action shall be confined to the diseased por- 
tions of the integument, as when made into a paint 
with traumaticin, or a solution of gutta-percha in 
chloroform. Used in the form of ointment, paste, or 
powder, on the other hand, it is easily transferred to 
the surrounding normal skin, and thus its chances of 
provoking irritation greatly multiplied. Its mischiev- 
ous action is much increased in hot weather. 

Mucuna pruriens. Cowhage. 

This vine grows both wild and in a cultivated state 
in the East and West Indies. The pods are covered 
with straight, prismatic, sharply pointed, retrorsely 
serrate hairs, one eighth of an inch long. 

According to the Dispensatory they easily penetrate 
the skin, and occasion intolerable itching, which is 
greatly increased by washing and rubbing. 

Oesterlen states that an ointment of cowhage hairs, 
gr. viii. in an ounce of lard {Ung. urticans), produces 
an immediate burning and urticaria. 

Bigelow, 1 in his essay on Mucuna, writes : " It is 
well known that when these bristles are rubbed on the 
skin they excite an intense and violent itching, which 
lasts for a considerable time. They have been some- 
times indiscreetly used as a counter irritant, applied 

1 Nature in Disease. 



102 DERMATITIS VENENATA. 

to the skin by spreading from four to six grains on 
lint and confining it with adhesive plaster. The re- 
sult, within my observation, has been an exceedingly 
uncomfortable itching and burning of the part, which 
on the second day becomes universally red and in- 
flamed. A copious eruption of papulae follows, which 
increases in size for a week, and at length terminates 
in pustules, which require a second week to pass into 
scabs. In one patient two or three large prominences, 
like boils, continued for ten days after the rest of the 
part was well. The application produced by cowhage 
appears to me greatly to exceed that which attends 
the application of flies or of tartar emetic." 

I am informed by a wholesale dealer in drugs, that 
so much trouble is occasioned by handling cowhage in 
the preparation of anthelmintics, that many in the 
trade refuse to deal in it. 

Our native species of Dolichos, according to Pro- 
fessor Goodale, are not known to possess irritating 
hairs. 

LILIACEJB. 

Allium sativum. Garlic. 

A native of Sicily. 

An application of garlic bulbs is advised as a coun- 
ter irritant to the chest in pulmonary diseases. They 
are capable of reddening the skin, and may even vesi- 
cate it. The same property, if in a less degree, is 
attributed to allied species, the leek, the onion, etc. 

Asparagus officinalis. Asparagus. 

Giintz, of Dresden, relates * the case of a woman em- 
ployed in a restaurant, whose sole occupation during 

1 Vierteljahrresschrift fiir Derm, und Syph., vii. 65. 



DERMATITIS VENENATA. 103 

its season was the preparation of asparagus cuttings 
for cooking. After a time her hands and arms pre- 
sented a diffused redness, moderate swelling, and in- 
numerable miliary vesicles. Her face and neck were 
somewhat swollen, and reddened also, and exhibited a 
few vesicles. There was marked conjunctivitis. The 
dermatitis subsided without treatment rapidly after 
leaving this occupation, but, on resuming it later, 
the arms again became red. The following year in 
asparagus time her face and arms again became ery- 
thematous when this occupation was resumed ; but 
it was persisted in, and without further injury. A 
niece of this patient had previously been affected in 
a similar manner, so as to be obliged to abstain from 
preparing asparagus in the restaurant. 

I can find nowhere a reference to such irritative 
action of asparagus upon the skin. It is one of the 
oldest culinary plants known, and was as much a 
favorite upon the tables of old Rome as at the present 
day. I have made inquiry at some of the largest 
restaurants of Boston, but their vegetable cooks have 
no knowledge of such properties. None of the chem- 
ical principles of the plant are known to be irritating. 
It should be placed upon the doubtful list, I think. 

Urginia scilla. Squill. 

This bulb grows chiefly along the shores of the 
Mediterranean. 

The juice of the fresh plant, according to the Dis- 
pensatory, acts upon the skin as a rubefacient. 



104 DERMATITIS VENENATA. 



LWACEM 

Linum usitatissimum. Flax. 

In 1875 Purdon l reported the occurrence of a pecu- 
liar form of acne upon the forearms of the operatives 
in the linen mills of Belfast, Ireland. It affected 
principally the young girls who remove the bobbins 
from the machinery and oil the same, and the spin- 
ners. The skin of the arms was described as harsh 
and dry, and covered with a papulo-pustular efflores- 
cence, having a shotty feel in its early stages, and 
accompanied by numerous comedones. The eruption 
was frequently observed upon the face, and was ac- 
counted for by wiping it with oily hands while per- 
spiring. The disease was attributed to the oil used 
upon the machinery, and to that contained in the flax. 
A certain kind of Russian flax was supposed to pro- 
duce a pustular efflorescence resembling that of variola. 
Treatment was of little service as long as the patients 
remained in the mill. 

This description closely resembles one of an eruption 
which occurs in factories where tarry preparations are 
used to lubricate the machinery, and where the air is 
saturated with tarry emanations. The formation of 
numerous comedones, and the shotty feeling papular 
efflorescence, are very suggestive of " tar acne." 

Prof. Leloir 2 describes an affection of the skin among 
flax spinners observed in his wards and at the works 
at Lille. It is seated upon the hands, more com- 
monly upon the left one, but is generally symmetrical. 

1 Treatise on Cut. Med. 

2 Annales de Derm, et de Syph., 1885, p. 129. 



DERMATITIS VENENATA. 105 

It affects principally the internal surface of the thumb, 
the external and palmar surfaces of the index finger, 
and the cubital and palmar border of the hand and 
little finger. In the most intense cases it may extend 
over the whole hand, and in exceptional instances up 
the forearms as far as the elbows. The inflammation 
is of an eczematous type, sometimes erythematous- 
vesicular, sometimes vesico-pustular or squamous. 
Most frequently, however, it has a dry lichenoid 
character. The skin is thickened, and its folds are 
more pronounced than natural. The epidermis is 
glossy, but sometimes slightly scaly, and nearly always 
more or less deeply fissured. There is often a marked 
thickening of the horny layer of the thumb and 
fingers. The nails are very rarely affected. There is 
a variable, but constant, degree of pruritus. All the 
workmen are not affected, — only three or four out 
of ten. Some are only affected when they work, the 
dermatitis disappearing in from one to two weeks 
after ceasing to labor. With others it is much more 
persistent, lasting for months after giving up work. 
Very rarely it affects the soles of workmen who go 
about habitually with naked feet. 

The affection is peculiar to the spinners who work 
the flax in a moist state. The threads are made to 
pass through a trough filled with very hot water, for 
the purpose of cleansing the flax of certain impurities, 
and in the manipulation of the threads the hands are 
kept constantly moist with the impure water from the 
trough, so that they become covered with a muci- 
laginous or gummy coating. This water is found to 
contain, as a result of fermentation, butyric and lactic 
acid combined with carbonate of lime in solution, and 



106 DERMATITIS VENENATA. 

it is to its character that Prof. Leloir ascribes the pro- 
duction of the dermatitis. The treatment recom- 
mended by him was a more frequent change of the 
water in the troughs, frequent washing of the hands, 
and the use of glycerine pomades and rubber gloves. 

It will be observed that in the cases described both 
by Purdon and Leloir, it is not the flax itself to which 
the inflammation can fairly be ascribed with certainty, 
as other elements, possibly irritative in character, may 
have been operative partially or wholly. In support 
of this view of the probably innocent character of the 
plant under all circumstances I offer the following 
replies to an inquiry kindly made, at my request, by 
the proprietor of one of the largest flax mills in the 
country, Charles T. Hubbard, Esq., since deceased. 

Mr. C. T. Hubbard. 

My dear Sir, — I received your letter, saying you would 
like my opinion on workers handling flax, and how long I have 
had persons working for me. I have had charge of workers 
thirty-four years, and I have worked in the mill fifty-two 
years altogether, and I must say I never saw any workers 
have the skin disease from handling flax. I have seen one 
or two instances where workers had to leave their work on 
account of a rash breaking out all over them, but it was from 
working amongst jute. It was reported that it was from using 
a certain kind of oil. 

I never saw nor heard of any one having skin disease from 
working amongst flax or any kinds of hemps. 

From yours truly, 

James Lane. 



Chas. T. Hubbard, Treas. Ludlow Manuf. Co. , Boston. 

Dear Sir, — In reply to your favor of some days since I 
have to say that I have had charge of the mills of the Ludlow 



DERMATITIS VENENATA. 107 

Manuf. Co. some eighteen years, where flax and flax tows have 
been worked by a considerable number of hands most of the 
time, and have carefully watched the effects of such employ- 
ment on the health of the employees as compared with those 
of other kinds of fibre manufactures I have been acquainted 
with, and fully believe that the employment in flax and similar 
manufactures is not in the least injurious. 

Old hacklers, who have spent their lives in preparing flax for 
spinning, have recently said to me that they have not seen a 
case of eruptive disease believed to be caused by handling flax. 

I have seen some cases of irritation of throat, and perhaps of 
the lungs, but they were persons easily annoyed by any kind 
of dust. 

Yours truly, 

L. H. Brigham, Agent. 



Charles T. Hubbard, Esq., Petersham, Mass. 

Dear Sir, — In reply to your inquiry of the 9th inst., I have 
been connected with the manufacture of flax, hemp, and jute 
for nearly twenty-two years, and have yet to learn of a single 
case of cutaneous disease caused directly or indirectly by the 
handling of either of these fibres. In an experience of ten 
years in the mills among hundreds of operatives, I found them 
usually healthy, their health averaging fully that of those in 
other employments. If there were any cutaneous diseases, they 
were caused in some other way than by their employment. 
In my experience I have found the invariable rule in all parts 
of the mill, where a man was injured by being cut or other- 
wise, to apply some soft flax or tow, that being there regarded 
as a sure cure for all such troubles. 

Very respectfully yours, 

C. N. Wallace. 



East Braintree, September 11, 1886. 
Mr. C. N. Wallace. 

In reply to your question, if in my knowledge flax was likely 
to cause skin diseases, I say no. In my experience of over forty 



108 DERMATITIS VENENATA. 

years' flax-dressing, during twenty-five years of which I had 
charge of that department in the Boston Flax Mills, and had 
under me twenty-five to thirty men, I found the following. In 
dressing or hackling flax, the flax is wrapped around the right 
and drawn through the left hand through a hackle tool, causing 
a constant friction, so that the skin of the left hand and under 
the right arm becomes quite transparent, and the blood oozes 
through. In very hot weather the skin becomes quite raw. I 
have known nearly all the hacklers in this country and many 
in Great Britain, and their invariable rule is to apply fine flax 
tow, from which they merely shake the dirt, putting a wad 
of that under the arm when the arm becomes sore, and doing 
up all scratches and bruises in the same manner. If you wish 
for any indorsement of my statement, you can get it of any 
flax mill in the world. 

I regard the fibre as a very healthy one. 

Very respectfully yours, 

James Wilson. 

Ludlow, Mass., September 10, 1886. 
Chas. T. Hubbard, Esq., Treas., Boston, Mass. 

My dear Sir, — In reply to your favor of the 9th inst., I 
have had particularly good opportunities for observing the 
condition of people accustomed most of their lives to work 
flax, and my opinion is, that they are not in the least degree 
subject to cutaneous diseases of any kind. 

I had charge for some years of one of the largest flax mills 
in Eussia. We employed about seven hundred operatives, 
working entirely on flax and flax tow. Most of these opera- 
tives lived in our own houses, and we had one house especially 
fitted up for the care of the sick ; we had some twenty cots, 
but rarely more than five or six occupied, and generally less 
than that. We had no cutaneous diseases except such as had 
a distinct cause quite apart from the mill. 

Our mill was situated in the heart of a flax-growing district, 
and we bought most of our flax from the peasant farmers direct. 
They were a very healthy people. 



DERMATITIS VENENATA. 109 

I have travelled very extensively in those districts of Eu- 
rope where flax-spinning is a leading industry. I never heard 
any diseases associated with the manufacture of flax except 
some of a pulmonary character. 

Yours truly, 

Jno. Ed. Stevens, Supt. 

It is well known that a flax-seed poultice often ex- 
cites a follicular inflammation, pustular or furuncular, 
in the area of skin to which it has been applied ; but 
it is not certain how much of this action is to be at- 
tributed to the oil which the seeds contain, and how 
much to the macerating effect of the heat, moisture, 
etc. of the application. 

Corchorus olitorius. Jute. 

In one of the letters published from the workmen 
in the flax mills (see page 106) it was stated that an 
instance of a rash occurring among workers in jute 
had been known. In the Berlin. Klin. Wochenschrift, 
1881, p. 503, an account is given of the diseases which 
prevail in jute mills, among which is eczema of the 
hands and arms. It is attributed by the writer, as in 
the letter above referred to, to the oil with which the 
fibres have to be saturated in order to work them. 

LOASACEM. 

Mentzelia oligosperma. Mentzelia. 

My attention was first called to the irritative prop- 
erties of these plants by Prof. Goodale of the Botanic 
Garden at Cambridge, who writes : " Mentzelia has 
grown in our garden, and has always been amazingly 
irritating to us all.' 7 



110 DERMATITIS VENENATA. 

The family is represented as possessing stinging 
hairs, and Figuier describes the hairs as charged with 
an acrid juice. 

The above-named species is a native of our Western 
and Southwestern States, and is provided with very 
rough barbed hairs. M. Floridana grows in South 
Florida, and M. Lindleyi is a showy Calif ornian species 
cultivated in our gardens under the name of Golden 
Bartonia. 

LOBELIACEJE. 

Lobelia inflata. Indian Tobacco. 

According to Piffard, this plant, abundant in all 
parts of the United States, when applied to the skin, 
is capable of producing an irritation. 

LOGANIACEJE. 

Gelsemium sempervirens. Yellow Jessamine. 

This handsome vine, growing abundantly in the 
Southern States, belongs to a family containing some 
of the most deadly poisons of the vegetable world. 
Its root contains gelsemine, a dangerous alkaloid. 

According to Mr. Cheney, many collectors of the 
root complain of its poisonous effects upon the skin. 

MELANTHACE^. 

Colchicum autumnale. Meadow Saffron. 

The Dispensatory states that the fresh corms, when 
applied to the skin, produce pricking and redness. It 
is a native of Southern and Central Europe. 



DERMATITIS VENENATA. Ill 

Veratrum viride. Indian Poke. 

Veratrum album. White Hellebore. 

The action of these two plants, probably identical, is 
closely allied to V. sabadilla, although their chemical 
principles are not identical. They are all powerful 
animal parasiticides. 

V. viride, our common native species, applied to the 
skin in a moist state, causes redness and burning, and 
V. album, the European representative, according to 
Piffard, may cause inflammation and vesicles. 

Veratria, applied in solution, or as an ointment, to 
the sound skin, produces a slight prickling sensation, 
and if used freely, according to the Dispensatory, may 
cause burning pain and vesicles. 

MYRTACMM. 

Eugenia pimenta. Pimento. Allspice. 

A native of Tropical America and the West Indies. 

When applied to the skin, according to the Dispen- 
satory, it rapidly produces a sense of warmth, which 
is followed by smarting and redness. Like Capsicum, 
it is mixed with Burgundy pitch or lead plasters to 
increase their stimulating action. 

Myrcia acris. Bayberry. 

This tree, known as wild clove, wild cinnamon, and 
bayberry, is a native of the West Indies and Tropical 
America. Its leaves yield on distillation a fragrant 
oil, which is used in the preparation of bay rum. In 
the West Indies bay rum is made by distilling the 
fresh leaves of the plant with a certain proportion 
of its fruit with St. Croix rum ; but most of this spirit 



112 DERMATITIS VENENATA. 

sold in the United States is manufactured here. The 
officinal formula is: oil of myrcia 16 parts, oil of 
orange-peel 1 part, oil of pimento 1 part, alcohol 1,000 
parts, water 782 parts. 

Bay rum is used as a perfume and popular wash for 
the skin. It is very commonly found upon the table 
of the barber and hair-dresser, and is often in my ex- 
perience the source of mischief in their establishments. 
I have treated a considerable number of cases of in- 
flammation of the scalp and face which have followed 
hair-cutting and shaving, and which I have ascribed 
to the irritating action of this preparation, which had 
been applied in each case. The inflammation was some- 
times in the form of an erythema, most pronounced 
about the openings of the hair follicles, and lasting 
from twelve to forty-eight hours, with much smarting 
and burning; sometimes a papular, advancing to a 
pustular eruption, with a generally reddened skin, a 
serious dermatitis lasting a week or ten days. Several 
instances of what seemed to be ordinary acute eczema 
of the scalp have been developed in this way. It is 
difficult to determine what is the real excitant in these 
cases, for in many of them, no doubt, the skin has 
been cut or scraped by the razor, or unduly stimulated, 
possibly excoriated, by the improper use of sharp- 
toothed comb and over-stiff brush before the rubbing 
in of the bay rum, which might have been applied to 
the sound skin without harm. Then the preparation 
is no doubt often made up in part of substances 
entirely foreign to its proper composition, which, and 
not its legitimate constituents, are the cause of the 
inflammation. Some of the worst cases which I have 
seen followed the single visit to some country barber- 



DERMATITIS VENENATA. 113 

shop, where cheap materials were no doubt employed. 
On the other hand, the officinal preparation, as above 
given, contains, in addition to the oil of myrcia, oil of 
orange-peel and of pimento, both of which are possible 
excitants of the skin. 

Although I am unable to state, therefore, that 
genuine West India bay rum is deleterious, I am none 
the less sure that the preparation so called, which is so 
universally used as a cosmetic, is sometimes the cause 
of serious dermatitis. 

ORCHIDACEJE. 

Cypripedium pubescens. Yellow Lady's- Slipper. 

Two of our lady's-slippers, have long been used in 
medicine, C. pubescens and C. parviflorum. I had 
never heard of any poisonous property attributed to 
them, and was greatly surprised to be informed by 
Prof. J. Nevins Hyde, of Chicago, that his friend, the 
late Prof. H. H. Babcock, a distinguished botanist of 
that city, found the C. pubescens, which grows from 
Canada to Georgia, nearly as irritating to him as Rhus 
toxicodendron, from which he suffered severely and 
repeatedly. 

Other, but more indefinite reports, sustain this 
character of the plant. 

Vanilla planifolia. Vanilla. 

This species is a native of Eastern Mexico, where it 
is also largely cultivated. Other species of inferior 
merit are found in other parts of Tropical America. 

According to the Dispensatory, workmen engaged 

in handling vanilla beans suffer from itching of the 

8 



114 DERMATITIS VENENATA. 

hands and face, and the skin is covered with a " prurigi- 
nous " eruption, and swells, reddens, and desquamates. 
These effects have been attributed to the action of an 
acarus, and to the presence of cardol, which is said to 
be applied to the pods for the purpose of producing 
the desirable brownish-black color. 

These statements may be true regarding the lower 
grades of vanilla, or those grown in some localities. 
On the other hand, I am informed by Mr. Burnett, of 
Boston, who has spent much time in the vanilla plan- 
tations and curing establishments of Mexico, and who 
uses great quantities of the beans in his well-known 
laboratory, that he has never known any irritation to 
be produced upon the skins of those employed in han- 
dling it at any stage. Every pod has to be turned 
several times a day, for several weeks after being 
gathered, to develop its best qualities. It should be 
stated, however, that he deals only in the very best 
quality, and employs as workmen only those who have 
especially dry skins, as a drop of perspiration or moist- 
ure coming in contact with the beans causes their 
destruction by the development of a fungus upon 
them. He does not believe that the first quality of 
the fruit is ever artificially colored. It may be 
interesting to learn that, in his opinion, the internal 
use of vanilla is ahoays perfectly harmless when pure, 
and that the extract prepared by his house is often 
drunk in considerable quantities as a liquor or cordial. 
He states that Tonka bean is very largely used as an 
adulterant in some manufactures of vanilla. 



DERMATITIS VENENATA. 115 

PAP A VER A CEjE. 

Chelidonium majus. Tetterwort. Celandine. 

This plant, a native of Europe, is cultivated widely, 
but it has become a roadside weed in many places. 

Loudon represents its orange-yellow juice as very 
acrimonious, and capable of destroying warts, ring- 
worm, and the itch. 

Van Hasselt states that the juice and bruised leaves 
act as a rubefacient and caustic. 

According to Oesterlen the fresh juice applied to 
the skin produces inflammation and blisters. 

The National Dispensatory says that the fresh plant, 
as well as the juice, irritates the skin. 

Piffard quotes authorities for the statement that it 
is acrid, irritant, and even escharotic. 

Mr. Cheney informs me that he has known the plant 
to poison the skin, if handled so as to crush the leaves 
or stem. 

To indicate the extent to which it is used in some 
form in medicine, it may be stated that a collector in 
North Carolina offers fifteen hundred pounds of the 
leaves for sale. 

Sanguinaria Canadensis. Bloodroot 

This interesting flower of early spring, growing 
throughout Canada and the United States, long ago 
attracted to itself the attention of physicians, presum- 
ably through its blood-red juice. 

Bigelow states that Prof. Smith cured polypi "of 
the soft kind " by applying the root. 

Oesterlen represents its root as sharply irritating. 



116 DERMATITIS VENENATA. 

Mr. Cheney informs me that the root has poisoned 
those handling it. 

Mr. Lloyd writes : " There are two native drugs that 
are very irritant to mucous surfaces, so much so that 
the dust is very disagreeable, and we presume that they 
would have a similar irritating action on the skin : 
Bloodroot, and Caulophyllum thalictroides, blue cohosh 
or pappoose-root. ,, 

The active principle has been called Sanguinarius. 

PHY TOLA CCA CEM. 

Phytolacca decandra. Poke. Garget. 

This striking looking plant grows in all parts of the 
United States. 

Bigelow states that it is stimulating when applied 
to the skin, frequently producing an eschar ; and that 
an ointment made of it excites a sense of heat and 
smarting, and that he has cured cases of psora (?) 
with it. 

A North Carolina collector of medicinal plants in- 
forms me that handling the green plant and root often 
produces inflammation of the skin. He has fifteen 
hundred pounds for sale. 

The Dispensatory states that the juice, or a strong 
decoction of the root, applied to the skin when tender 
or abraded, causes smarting or burning pain. 

Mr. Lloyd writes : " Fresh phytolacca applied to the 
skin produces an irritating action, and we think it 
should be certainly classified among the plants you 
are considering." Its action upon workmen in his 
laboratory is described as similar to that of Podo- 
phyllum, causing serious inflammation of the eyelids. 



DERMATITIS VENENATA. 117 

PIPER AC EM 

Piper nigrum. Black and White Pepper, 

This is an Indian shrub, now cultivated in many 
tropical islands. Many other species are also culti- 
vated for their pungent properties as condiments. The 
active principle is pepperine chiefly. 

Applied to the skin, ground pepper causes severe 
pain and redness, and is sometimes used as a local 
stimulant. It may even produce vesication. 

POLYQONAQEM, 

Polygonum hydropiper. Smartweed. Water Pepper, 
Polygonum acre. 

Common in most of the United States. 

Gray states that the juice of these plants is very 
acrid, and I am informed by a large dealer in our 
native medicinal plants that the former irritates the 
hands and face of the collectors, causing itching and 
burning. 

BANUNCULA OEM. 

Aconitum napellus. Monkshood, 

Common in cultivation. 

The Dispensatory states that the ointment produces 
on the sound skin an itching and prickling without 
redness. 

Piffard quotes authorities for its power to excite 
redness and vesicles. 

Working the plant for aconitia often produces severe 
inflammation of the skin, according to Lloyd. 



118 DERMATITIS VENENATA. 



Actaea spicata. Baneberry. 

Piffard attributes vesicating properties to this plant, 
common in the Northern States. 



Anemone nemorosa. Wood Anemone. Wind-flower. 
Anemone patens. Pasque-flower. Pulsatilla. 

The first-named species, of wide occurrence, is one 
of our earliest and most plucked wild-flowers of spring, 
and T have not known that it has caused trouble to 
any one thus handling it, but I am informed by a large 
wholesale dealer in our medicinal plants that it is 
regarded as an external corrosive poison, as is the Pul- 
satilla also. 

The National Dispensatory states that the bruised 
fresh plant of Anemone pratensis, 8b Western species, 
when rubbed upon the skin, irritates and may even 
vesicate it, and that similar acrid properties, due to 
anemonin, exist in other species. 

PifHard quotes authorities who represent both the 
species named as capable of producing redness, vesicles, 
and even ulcers. 

Oesterlen states that Pulsatilla is locally an irritant. 

Lloyd states that all the plants containing anemonin 
are troublesome in the laboratory in the process of 
extracting the latter. 

It will be well to bear in mind this character of the 
Anemones in cases of dermatitis following the gather- 
ing of wild-flowers in early spring. 

Clematis. Virgiri s-Bower. 

Numerous species of this plant are natives of the 
United States, and several are cultivated for their 



DERMATITIS VENENATA. 119 

showy blossoms. The most common of the former, 
growing in all parts of the United States, is C. Vir- 
giniana. The herbage of all is acrid and caustic, 
according to the text-books of botany. 

The Dispensatory represents all the species, especially 
the European (C. erecta, etc.), as possessing essentially 
the same properties, those of an acrid irritant. The 
juice of the plant, or the bruised plant applied to the 
skin, is apt to cause blisters, or even ulcers, and the 
emanations, when it is crushed, readily make the eyes 
water and become inflamed. The fresh leaves are used 
as a vesicant in Europe, and beggars produce sores on 
their limbs with them purposely, so that the plant is 
there called beggar' s-weed. An infusion of the plant 
in oil has been used to cure the itch, and violent in- 
flammation of the skin has been produced by friction 
with it. 

Lloyd writes to me that, " in working Clematis for 
anemonin, our hands were blistered several times. ,, 

Delphinium consolida. Larkspur. 

Delphinium staphisagria. 

My attention was first called to the poisonous action 
of the Delphinia upon the skin by Dr. F. C. Shattuck, 
of Boston, two years ago, who reported to me the 
following case which occurred in an orphan asylum 
under his professional charge. Sister M. applied a 
preparation of the seeds of "larkspur" soaked in al- 
cohol upon the heads of several children for the 
purpose of destroying lice. The use of Delphinium 
staphisagria, or staves-acre, for such an object is well 
known. Three days afterwards, an acute dermatitis 
resembling eczema appeared upon the face and hands, 



120 DERMATITIS VENENATA. 

which lasted a week. The patient had never had 
eczema nor used "larkspur" previously. 

We have in the United States several species of 
Delphinium, but none of them appear to have been 
used in medicine. D. eonsolida, however, is much 
cultivated, and has become naturalized in some parts 
of the country. Mr. Cheney informs me that this is 
the species mainly sold in this country, and is largely 
raised here. A tincture of the seeds mixed with those 
of Lobelia inflata is sold in great quantity as a para- 
siticide. 

The active principle of the genus is delphinin, and 
this, according to Van Hasselt, is a mild vesicatory. 
Oesterlen says that it produces great burning and in- 
flammation when applied to the skin, and the National 
Dispensatory states that an ointment containing it, 
when rubbed upon the skin, causes burning, prickling, 
and a transitory redness, such as veratrin occasions. 

Helleborus niger. Black Hellebore. Christmas Rose. 

It is a native of Southern Europe. The rhizome is 
the part used in medicine. 

Piffard ascribes to it vesicating properties. 

Ranunculus. Buttercups. 

Some twenty species of native and naturalized 
Ranunculi grow in the United States, most of which 
contain a very acrid juice. 

Bigelow states that, before the introduction of can- 
tharides as a vesicatory, different species of them were 
used upon the skin as external stimulants. Their 
power of occasioning erosion and ulceration appears 
to have been known to the ancients. A slice of the 



DERMATITIS VENENATA. 121 

fresh root of R. bulbosus, one of the most common 
buttercups, placed in contact with the inside of the 
finger, brought on burning in two minutes. "When 
taken off, the skin was found without redness, and 
the sensation of heat and itching ceased. In two 
hours, however, it returned, and in ten hours a full 
serous blister was raised. This was followed by an 
ulcer of a bad character, and difficult to heal. The 
leaves, flowers, and buds also of R. bulbosus, acris, 
sceleratus, etc., excite redness and vesication if ap- 
plied to the skin, and were used as rubefacients in 
rheumatism, hip disease, and hemicrania. Applied 
to the scalp, they produce tumefaction, but no dis- 
charge. He quotes Tissot's report of a case, in which 
an application to the thumb caused a deep and painful 
ulcer, which penetrated to the bone and required some 
months to heal. In another case, a blister thus pro- 
duced spread over the whole arm, occasioning fever 
and delirium. Other cases of similar spreading in- 
flammation are reported by him. He finds that upon 
some persons the plants do not act. Cattle will not 
eat them while fresh, but when dry they produce no 
harm when mixed with the hay. 

Loudon states that R. sceleratus, common in the 
United States, may be considered one of the most 
virulent of English plants. Bruised and applied to 
the skin, it soon raises a blister, and makes a sore by 
no means easy to heal. Strolling beggars are said to 
use it for this purpose to excite compassion. R. bul- 
bosus also possesses the property of inflaming and blis- 
tering the skin, especially the root ; and R. acris and 
repens often cause inflammation of the palms when 
the plants are pulled up. 



122 DERMATITIS VENENATA. 

Van Hasselt describes several of the species as 
powerfully caustic, and capable of producing deep 
destruction, and even gangrene. 

Our Dispensatory states that fresh R. bulbosus 
bruised may be used as a counter irritant ; and that 
the acrid principle exists in a golden yellow volatile 
oil, which is readily changed into anemonin and anem- 
onic acid. 

Mr. Lloyd writes : " A large family of plants con- 
taining anemonin, such as Ranunculus, etc., are prop- 
erly irritants. In working them for anemonin in our 
laboratory, our hands were blistered several times by 
contact with these principles." 

In virtue of this stimulating action upon the skin, 
I tried the effect of an application of their juice upon 
the scalp, on one occasion, in a case of alopecia. A 
single application produced such peculiar sensations, 
numbness of the scalp, headache, confusion of thought, 
etc., that the patient did not dare to repeat the exper- 
iment, nor I to advise it. 

BUBIACEJE. 

Cephaelis ipecacuanha. Ipecac. 

This plant is a native of Brazil, and its active prin- 
ciple is an alkaloid called emetine, a powerful local 
irritant. 

According to the Dispensatory, the dust or efflu- 
vium of the root is apt to occasion inflammation 
of the air-passages and conjunctivitis, and applied 
to the skin in the form of an ointment it excites 
a pustular eruption similar to that caused by tartar 
emetic. 



DERMATITIS VENENATA. 123 

Piffard quotes several authorities with regard to 
its action upon the skin, which is described as capa- 
ble of producing erythema, papules, vesicles, and, ac- 
cording to Duckworth, small, discrete pustules, with 
a rather large areola, and afterward, if the applica- 
tion be persisted in, large pustules, followed by severe 
ulceration. 

Bazin describes the action of an ointment composed 
of one part ipecacuanha and two parts lard : " After 
from two to four gentle frictions, the skin presents 
diffused erythematous patches, followed after a time 
by a few quite large, discrete, and red papules. They 
disappear very slowly, changing to a bluish or violet 
color, and only fading entirely away after two weeks. 
The eruption is accompanied by an intense degree of 
pruritus, so that the tips of the papules are often ex- 
coriated and covered with bloody crusts. The inflam- 
mation is followed by no exfoliation." 

Cinchona. 

The many species of trees yielding cinchona barks 
are natives of Tropical South America. I can find no 
reference to the occurrence of any inflammation of the 
skin produced by contact with the crude bark or other 
parts of the trees, but quinia and its compounds seem 
to possess this property. 

According to the Dispensatory, such eruptions are 
not uncommon among the workmen in the manu- 
factories of quinine, and a " lichenoid " efflorescence 
has been produced by a bath containing sulphate of 
quinine. When applied to the denuded cutis, this 
salt occasions severe burning and smarting pain, and 
sometimes forms a superficial eschar. 



124 DERMATITIS VENENATA. 

Bazin gives the results of an inquiry addressed by 
Chevallier to the principal factories in France, Ger- 
many, and England, in the following conclusions. 
The workmen employed in the fabrication of sulphate 
of quinine are liable to cutaneous disturbances, which 
sometimes force them to abandon the occupation. 
These accidents are very common in Germany and 
France, less frequent in England. They affect almost 
exclusively those who boil the bark, those who convert 
the quinine into the sulphate, and those who place the 
latter in bottles. The same effects have sometimes 
followed a simple residence in the factories without 
employment in them. They consist of erythema, vesi- 
cles, pustules, and crusts, seated upon the hands and 
forearms, the face, and genitals, and in exceptional 
cases over the whole surface. They are accompanied 
by great itching. The eruption lasts from a fortnight 
to a month. These effects are produced, not by the 
mechanical action of particles, but to quinine emana- 
tions. He cites also cases in detail under his own 
observation. All the workmen do not appear to be 
similarly disposed to the affection, and some of them 
are employed for years in the factories without harm ; 
whereas others are so easily affected that a few hours 
in the laboratory will develop itching, and subse- 
quently the cutaneous inflammation. In some persons 
the attacks become less and less severe, and gradually 
cease; but others are obliged to relinquish the work 
forever. 

I am informed by Messrs. Kosengarten and Sons of 
Philadelphia, one of the largest manufacturers in this 
country, that occasional cases of the rash occur among 
their workmen. They state that " those attacked by 



DERMATITIS VENENATA. 125 

it seem to have an idiosyncrasy that renders them 
unfit for this work. The rash is generally of a very 
mild character, and soon disappears when they are 
put to other work." 



RUTACEjE. 

Ailanthus glandulosa. Tree of Heaven, 

Introduced from China. 

Some years ago I read in some medical journal an 
account of suspected poisoning by this tree during its 
flowering season. I made no memorandum of the 
case at the time, and am unable to find any reference 
to it, but I remember that it was characterized by a 
marked dermatitis of the face especially, which was 
attributed by the recorder to the emanations of this 
tree, which grew very near the sleeping-chamber of 
the patient. 

I am informed by a person thoroughly acquainted 
with the properties of our native plants, that he 
knew the case of a lady who was poisoned by contact 
with it. 

Certainly its intensely disagreeable odors during 
the flowering season are a warning against approach 
to it. 

We have evidence enough against it to regard it as 
an object of suspicion. 

Pilocarpus pennatifolius. Jaborandi. 

This is a shrub growing in Brazil. Several other 
plants are known by this title, jaborandi. From it 
the alkaloid pilocarpine is obtained. 



126 DERMATITIS VENENATA. 

In addition to its stimulation of the sweat glands, 
the statement is made by the Dispensatory, that the 
powder irritates the skin by prolonged contact with it. 

Ruta graveolens. Garden Rue. 

A native of Southern Europe. 

My attention was first called to the poisonous char- 
acter of garden rue by a statement in Bigelow's chap- 
ter on Rhus, in which he says : " Even the garden 
rue is said to affect some persons in a similar man- 
ner/' Our Cambridge authorities in botany had no 
knowledge of such property, so that I was surprised 
to learn how widely and long it has been regarded 
with suspicion. 

Loudon remarks, that in its recent state the leaves 
will inflame and blister the skin, but much of this 
power is dissipated by drying. 

Van Hasselt says, " Handling the flowers and fruit 
produces an erythematous inflammation, with burning, 
itching, and vesication, lasting several weeks." 

Oesterlen says, that externally used it produces an 
inflammation of the skin. 

Piffard quotes Soubeiran, ascribing to it the power 
of producing redness, vesicles, and desquamation. 

The Dispensatory gives the case of a man who, 
after gathering rue, suffered from inflammation of 
the forearms with abundant vesicles, which healed 
very slowly. It states that among the ancients it was 
known to cause a pustular eruption upon the hands of 
those who gathered it,[and was used to destroy fleasj 

Bazin relates the case of a druggist who experienced 
violent itching of the hands after collecting specimens, 
and on the following day had an eruption upon them 



DERMATITIS VENENATA. 127 

of vesicles in groups. After two days these had ex- 
tended and formed by confluence large bullae. This 
condition persisted for ten days, and terminated in 
exfoliation. For a space of three weeks small groups 
of vesicles continued to appear. On the following 
year this person again gathered specimens of the 
plant, but took the precaution to take the branch 
only between the finger and thumb, and to cut it 
below with scissors; but the experiment was imme- 
diately followed by an inflammation, still more in- 
tense, of three weeks' duration, which covered the 
whole surface of the right hand. 

The plant is upon the list of the materia medica, 
and I am informed by a large dealer that it is dis- 
agreeable for many to handle when green. 

SALIC AC EjE. 

Populus candicans. Balm of Gilead. 

One of the most popular household remedies for 
external use in some parts of New England, for sev- 
eral generations back, has been the bottle of balm of 
Gilead buds preserved in rum or alcohol. The leaf- 
buds, which are picked in the spring, are large, of a 
varnished brownish appearance, and are saturated 
with a strongly odorous resin, which fills the neigh- 
borhood of the tree with its penetrating fragrance. 
The tree was formerly much cultivated around New 
England homes, and is found growing sparsely in a 
wild state in the Northern United States and Canada. 
Possibly its popular name, as well as the strong odor 
emanating from it, gave to it a reputation for healing 
virtues. The tincture, prepared in the household by 



128 DERMATITIS VENENATA. 

turning rum or alcohol upon the buds in a bottle, has 
a brownish color, and retains the strong odor of the 
tree in spring. It is used chiefly as an application to 
the skin after bruises, cuts, and sprains, — for such 
purposes, in fact, as its more fashionable successors in 
household therapeutics, tincture of arnica and extract 
of hamamelis, are now so commonly employed ; but 
it has not yet been wholly supplanted by these. Mr. 
Cheney, of a firm of dealers in our native drugs, 
informs me that he sells three hundred pounds of the 
buds a year, which mostly go to the Western States. 
The tincture is sometimes rubbed into the skin, some- 
times laid upon it as an evaporating lotion, or applied 
as a fomentation. The sensations generally produced 
in the skin when thus used are slight glowing, or 
smarting, if the skin be broken or excoriated. Upon 
the majority of persons it produces no other apprecia- 
ble effect ; but in some cases — how frequently it is 
impossible to determine — it causes a very severe 
inflammation of the skin, resembling, but exceeding 
in intensity, that which results from the similar use 
of tincture of arnica. I have seen instances enough 
to enable me to recognize the nature of this derma- 
titis with a considerable degree of certainty at sight, 
and to distinguish between the cutaneous appearances 
produced by it and other irritants, although it would 
be impossible for me to present a table of positive 
points of difference. An intense grade of erythema, 
a deep cedematous infiltration, and a formation of 
large bullae, are the most characteristic features of 
the dermatitis. I have not seen the uniform papular 
efflorescence which occurs so often in mild cases or 
early stages of dermatitis from arnica, nor have I 



DERMATITIS VENENATA. 129 

ever seen an inflammation excited upon other parts 
than those to which the preparation was directly 
applied ; whereas after the use of tincture of arnica 
portions of the skin remote from those to which the 
treatment has been addressed are very frequently 
affected through contact with the hands or bandages 
while wet with it. The duration of the inflammatory 
process is in proportion to its intensity, and the skin 
has, in the cases under my observation, always re- 
turned to a normal condition in periods varying from 
two to six weeks. 

The following brief account of a case in my service 
in the skin department of the Massachusetts General 
Hospital will illustrate its action. A man thirty 
years old sprained his elbow, without in any way 
injuring the skin. The limb was rubbed with the 
balm of Gilead liniment, and bound up over night in 
a cloth soaked in the same. On the following day 
the arm was somewhat swollen and very red, and the 
inflammation increased to such an extent that on 
the next day the patient applied for treatment at the 
hospital. The whole limb, from the shoulder down, 
including the hand, was enormously swollen, and of a 
deep crimson color. Over large areas serum was 
freely oozing from the general surface, as if the 
epithelium were uniformly washed away from such 
portions by the intensity of the inflammatory process 
beneath, and as if there had not been time for the for- 
mation of the primary lesions which usually precede 
such a dermatitis madidans. There was scarcely any 
appearance of papules or vesicles, even at the periph- 
ery of the affected integument. On the other hand, 
there were many bullse upon the back of the hand, and 



130 DERMATITIS VENENATA. 

upon some parts of the arm, varying in size from a 
pea to a pigeon's egg. The contents were not distin- 
guished by any peculiar coloration. The sensations 
in the limb were very distressing, — a great burning 
and feeling of distention. There was no marked 
constitutional disturbance. Under treatment the arm 
continued tensely swollen and vividly red for three or 
four days, with continual serous discharge ; after 
which the inflammation very slowly subsided, with 
the formation of the ordinary secondary lesions of 
involution, namely, crusts and scales, which, with the 
redness and gradually diminishing oedema, persisted 
for some two weeks longer. Only a mild degree of 
superficial suppuration was observed. 

In other cases, where the liniment has been longer 
used, in consequence of mistaking the dermatitis for 
the effects of the injury for which it was applied, — 
a very common error, — the inflammation has been 
of longer duration ; but its characteristic phenomena 
have been those above given. Occasionally, under 
continued scratching, the process has passed into a 
true eczema, with a more or less chronic course. 

The frequency of occurrence of these cases cannot 
be readily ascertained, as its use is chiefly in rural 
communities, and the possibly " poisonous " action of 
the plant is not generally known. I find, in fact, no 
reference to such property in any of the works on 
dermatology or materia medica I have consulted, yet 
every year I see a case or two in my clinic at the 
hospital. To those who meet with exceptionally 
severe cases of dermatitis after injuries, I would sug- 
gest the inquiry whether this liniment may not have 
been used before its development. 



DERMATITIS VENENATA. 131 

Treatment, such as similar grades of dermatitis 
demand. Kest for the limb in a horizontal position ; 
the application of evaporating lotions of spirit and 
water ; the use of the washes advised in the treatment 
of Rhus poisoning ; or, if more soothing, enveloping 
the part in cloths spread with bland ointments. 



SCR OPHULARIA CEJE. 

Verbascum thapsus. Mullein. 

The leaves of our common mullein, introduced from 
Europe as a roadside weed, are thickly covered with 
woolly hairs which are irritating to the skin. They 
are often applied to the throat externally, in some 
parts of the country, to produce a rubefacient effect. 



SOLANACEJE. 

Capsicum fastigiatum. Red Pepper. 

This and several other species, C. longum, annuum, 
smdfrutescens, furnish the well-known red peppers of 
the table and pharmacy. Their active principle is a 
crystallizable body called capsaicin. They are sup- 
posed to be natives of Central America, but are now 
cultivated in most countries. 

The rubefacient property of Capsicum is well known, 
as it is often applied to the skin as a domestic remedy 
for this purpose, and it is much used in the manu- 
facture of stimulating plasters. If its action be long 
continued, the inflammatory process may advance to 
vesicle formation. 



132 DERMATITIS VENENATA. 

Datura stramonium. Jamestown-weed. 

A common weed in waste grounds, introduced from 
Asia. 

Mr. Cheney informs me that it poisons the eyes of 
those who collect it for medicinal purposes, causing 
their eyelids to swell. 

Stramonium ointment produces no irritation upon 
the skin, so far as I am aware. 



THYMELEACEM 

Daphne mezereum. 

This is a shrub indigenous to the high latitudes of 
the eastern continent. Two other species with similar 
properties, D. gnidium and D. laureola, are found in 
Southern Europe. The bark, as is well known, is used 
both internally and in the form of an ointment. 

Loudon states that the whole plant is extremely 
acrid, and that in France the bark is applied to the 
skin for the purposes of a " perpetual blister." 

Oesterlen remarks, that all parts of the plant pro- 
duce on contact irritation and inflammation, and that 
the tincture, extract, and ointment are used as a 
rubefacient. 

According to the Dispensatory, the bark when fresh, 
or after soaking in water, reddens the skin, and at 
length occasions vesicles followed by painful ulcers, 
which are difficult to heal. It mentions the case of a 
girl on whose cheek the fresh juice of the plant was 
rubbed. This was followed by extreme swelling, pain, 
and a vesicular eruption. It states that the commi- 
nution of the bark requires some precaution to avoid 



DERMATITIS VENENATA. 133 

the injurious effects of the dust, although its poisonous 
action is generally limited to the mucous membrane 
of the workmen. It represents the nature of the 
active principle as uncertain. 

Dirca palustris. Leatherwood. Moosewood. 

This shrub grows abundantly in the Northern United 
States and Canada, and more sparingly in the South- 
ern States. It is noted for the toughness of its 
fibres. 

The Dispensatory states that all parts have a 
nauseous acrid taste, and contain an unknown acrid 
principle. The fresh bark applied to the skin causes 
redness and vesication, and sores which are very diffi- 
cult to heal. 

TBOP^OLACUJE. 

Tropaeolum majus. Garden Nasturtium. 

The common garden nasturtium, a native of Peru, 
so abundantly cultivated of recent years, and in such 
gorgeous variety of coloring, possesses, as is well 
known, a pungent taste in all its parts, resembling 
that of the Cruciferse, which makes its seed capsules, 
when pickled, a pleasant condiment. Beyond this 
slightly warming or stimulating effect upon the mu- 
cous membrane, it is not supposed to exert any ex- 
citing action upon the human tissues. In exceptional 
cases, however, it may give rise to a decided inflam- 
mation of the external skin. In two persons I have 
known it to produce a dermatitis repeatedly, and in 
other instances I have suspected, but could not posi- 
tively determine, that it has been the exciting cause 



134 DERMATITIS VENENATA. 

of similar troubles. Its action may perhaps be best 
illustrated by a brief description of the cases. 

Case I. — A few years ago a lady of thirty or more 
years presented herself to me for treatment of an 
apparent acute eczema of papular and vesicular type 
upon the hands, the inflammation being most advanced 
upon the fingers, including the palmar surfaces. There 
was little in the appearances to suggest an artificial 
or extraneous origin to the inflammation, with the 
exception of a rather unusual preponderance and ex- 
aggerated development of vesicles. On inquiry it 
was ascertained that the patient had been engaged 
for a long time in handling the plants in an exten- 
sive nasturtium bed two days in succession before the 
eruption appeared, and that she had noticed on both 
occasions an immediate itching sensation in the hands. 
The course of the affection was that of an acute 
eczema of similar grade under local treatment. The 
following year, at the same season, this whole history 
repeated itself. A morning's work in training the 
young nasturtium creepers was followed by the devel- 
opment of an identical dermatitis, scarcely varying 
to an appreciable degree from an ordinary eczema. 
Since then she has avoided contact with this flower. 

Case II. — A young lady consulted me for an acute 
inflammatory affection of the right hand. The lateral 
surfaces of the fingers were thickly occupied by vesi- 
cles, which were more sparsely scattered also over their 
dorsal surfaces, the back of the hand, and the wrist. 
Upon the inside of the whole hand similar lesions 
were seen imbedded in the thickened epidermis, un- 
able to assume their ordinary dome-shaped roofs. The 
subjective symptoms were great heat and itching. 



DERMATITIS VENENATA. 135 

Two or three days previously the patient had picked 
with the bare right hand a large bunch of nastur- 
tiums, and subsequently carried them for a consider- 
able time in the same hand. The left hand had 
remained gloved all this time, and did not come in 
contact with the plant or flowers. As nearly as she 
could remember, she had washed her hand within an 
hour after picking the flowers. On the following day 
she felt an itching in the hand, and within twenty- 
four hours after contact the eruption had become 
noticeable. The appearances when seen by me could 
not be distinguished from an ordinary acute eczema 
in its fullest development. Subsequently many of 
the vesicles upon the lateral and dorsal surfaces be- 
came confluent, ruptured, oozed, and crusted, accord- 
ing to the ordinary course, and then the whole process, 
under treatment, rapidly underwent involution, so that 
the complete duration did not exceed fourteen days. 
Two years later a similar attack of eczema-like derma- 
titis followed the inadvertent handling of nasturtium 
plants before the flowering season. Since then she has 
had no cutaneous disturbances, with the exception, ten 
years later, of an artificial dermatitis of the back of 
the neck, following the application to the scalp of 
stimulating applications in the course of treatment for 
alopecia areata, showing that her skin is very sus- 
ceptible to the action of irritants. 

The type of the dermatitis in both these cases was 
purely eczematous ; indeed, it would be impossible for 
one well skilled in dermatology to distinguish it from 
exceptionally uniform but possible vesicular eczema. 
It may be wrong to call it anything else ; if so, we 
may then say with certainty that these patients would 



136 DERMATITIS VENENATA. 

not have had the eczema without contact with nastur- 
tiums, or that this plant is capable of exciting an 
eczema. To this view I see no objection. 

No mention of such irritative action of the nastur- 
tium is to be found in books of botany or in medical 
writings, so far as I have been able to consult them ; 
but its near resemblance to the Crucif erae in its pungent 
properties makes it probable that such cases may not 
be of infrequent, although unrecognized occurrence. 

UMBELLIFERJE. 

Ferula galbaniflua. 

This plant is a native of Northern Persia. It exudes 
spontaneously a gum resin, known in pharmacy as 
galbanum. 

Applied to the skin, according to the Dispensatory, 
it occasions a papular efflorescence, and if the true 
skin be exposed it causes it to ulcerate. 

Piffard represents it as rubefacient and irritant to 
the tender skin. 

Heracleum lanatum. Masterwort. Cow-Parsnip. 

Growing in all parts of the country north of Penn- 
sylvania. 

This plant occupies a prominent position upon the 
list of the " botanic " practitioner, and finds a place 
in our Dispensatory also, which describes it as pos- 
sessing a rank odor and a pungently acrid taste. Its 
leaves applied to the skin may produce vesication, 
and have been used as a counter irritant. The active 
principle is not known. 



DERMATITIS VENENATA. 137 

Thapsia garganica. Thapsia. 

This herb is a native of Northern Africa and South- 
ern Europe. 

The Dispensatory states that its acrid principle is a 
resin. This applied to the skin produces an intolerable 
itching and a copious vesicular eruption. If the action 
is prolonged, the eruption becomes confluent and leaves 
a suppurating, ulcerating surface, with subsequent 
scars resembling those of small-pox. The juice also 
irritates the skin, and workmen employed in making 
the extract are much troubled by swelling of the hands 
and face. It also states that in the Therapeutical 
Society of Paris, in 1882, all its leading members con- 
demned thapsia plasters as unnecessary and as some- 
times dangerous. 

Bazin remarks that its application produces an erup- 
tion remarkable for the numerous and uniform vesicles, 
and for the rapidity with which pus forms in them. 



URTICACEM 

Urtica. Nettle. 

Laportea. Wood Nettle. 

There are two genera of the Urticaceae in the United 
States which possess stinging properties, Urtica and 
Laportea. The former, in addition to the native spe- 
cies, is represented by the well-known Urtica dioica 
and U. urens, introduced from Europe and of common 
occurrence in waste places. The native stinging spe- 
cies are U. gracilis, common in New England and 
Canada ; U. purpurascens, growing from Kentucky 
to Louisiana ; and U. chammdryoides, from Kentucky 



138 DERMATITIS VENENATA. 

southward ; also Laportea Canadensis, in the moist rich 
woods of Canada and the United States. 

Some years ago, while collecting plants for my her- 
barium on a hot summer day, I found growing on the 
edge of a stream in a wood a plant, with large leaves 
on slender petioles and inconspicuous flowers, with 
which I was unacquainted. I picked several speci- 
mens, which I placed in my box without stopping to 
examine them. Within two or three minutes I per- 
ceived a sensation of burning on the back of my 
thumb, and, seeing that the part was somewhat red- 
dened, concluded that I had been bitten by a mosquito. 
In a few minutes later, however, the whole radial half 
of the dorsum of the left hand, in which the plants 
had been so briefly held, became violently red, and 
presented numerous well-marked wheals of circular 
shape and boldly prominent. The skin of the part 
within five minutes was considerably swollen. The 
sensations were an intense burning with a moderate 
degree of itching. I then suspected the nature of the 
plant, and placed my hand in the brook, retaining it 
there for ten minutes. Even under water the wheals 
continued to develop for this period, gradually becom- 
ing confluent and forming a uniform densely hard 
thickening of the skin. Subsequently I bound the 
hand up in a wetted handkerchief, and on my return 
home after an hour's walk the skin had nearly re- 
turned to its natural appearance, but it continued to 
itch and burn for two or three hours longer, and later 
a slightly benumbed sensation in the part was expe- 
rienced. The plant, on examination, proved to be 
Laportea Canadensis, or the wood nettle, handsomer 
but rarer than our stinging species of Urtica, and pre- 



DERMATITIS VENENATA. 139 

senting in its appearance nothing to excite suspicion 
as to its venomous nature. 

This was a typical but mild illustration of the 
stinging properties of the Urticse, from which our 
term urticaria has been derived. The action of their 
stinging-glands is at times, however, much more vio- 
lent and of longer duration, according to extent of 
cutaneous surface affected and individual susceptibility 
of the victim. Urtication was formerly practised for 
the cure of paralysis, impotence, lethargy, etc., and 
consisted in beating the skin with a bunch of nettles. 
The result was the development of an immediate hy- 
peremia or erythema, and an abundant efflorescence 
of wheals. After the third or fourth successive appli- 
cation the skin ceases to react under fresh contact. 

An excellent account of the anatomy of the stinging 
organs of the nettle is given by J. Duval- Jouve. 1 His 
observations were made upon Vrtica urens, dioica, and 
pilulifera. According to his investigations, they possess 
three kinds of hairs, only one of which has stinging 
properties. These are unequally scattered over all 
parts of the plants. They consist of a needle-like cell, 
with a bulbous dilatation at the base, and terminat- 
ing in a somewhat blunted or swollen point, which is 
bent upon itself at a right angle at the extreme tip. 
They are erect and about two millimeters in length. 
They are hollow to the extremity of the point, and are 
filled with a colorless transparent liquid, holding in 
suspension a fine granular matter. The walls of this 
needle-like cell contain numerous vacuoles arranged 
in a spiral manner. If one of the stings be applied 

1 Etude sur les Stimules d'Ortie. Bull, de la Soc. Botan. de France, 
XIV. 36. 



140 DERMATITIS VENENATA. 

with the forceps gently to the skin, it will be seen by 
the aid of a lens that the tip has entered and been 
broken off within the epidermis, appearing as a minute 
white point, and that a little liquid is spread upon the 
surface round about. If the tip be merely touched 
with the point of a needle, it will be seen to rupture 
and discharge its fluid contents, while the sting itself 
elongates and contracts. If a needle be dipped in this 
liquid and inserted in the skin, the ordinary stinging 
sensations are produced, but only feebly and briefly. 
Dipped in the fluid of the bulb, the sensations thus 
produced are still more feeble. The liquid taken from 
the tip gives a distinctly acid reaction with litmus, 
whereas that contained in the bulb does not. If the 
plant be seized boldly with the hand, many of the 
stinging glands fail to pierce the thickened epidermis 
of the palm ; but in the folds of the articulations, on 
the lateral surfaces of the fingers and the back of the 
hand, and upon the wrist, numerous stings will always 
succeed in implanting themselves. The sensations are 
generally almost immediately noticeable, and in some 
parts last for a short time only ; in others they last 
for a whole day even. 

These effects of contact with American and European 
species of Urticse are trifling compared with the action 
of those growing in the East Indies. The most venom- 
ous of these are U. urentissima, U. crenulata, TJ. stimu- 
lans, and U. ferox. The third of these, according to 
Van Hasselt, produces at first only a mild burning, 
which increases in an hour to most raging pain, with- 
out swelling or redness. The pain extends over the 
whole body, and lasts twenty-four hours, accompanied 
by trismus. It begins to abate on the following day, 



DERMATITIS VENENATA. 141 

but does not wholly disappear for a week. Figuier 
quotes the following account of the action of U. crenu- 
lata by De la Tours. " One of the leaves slightly 
touched the first three fingers of my left hand. At the 
time, I only perceived a slight pricking, to which I paid 
no attention. This was at seven in the morning. The 
pain continued to increase. In an hour it had become 
intolerable ; it seemed as if some one was rubbing my 
hand with a red-hot iron. Still there was no remark- 
able appearance, neither swelling, nor pustules, nor 
inflammation. The pain spread rapidly along the arm 
as far as the armpit. I was then seized with frequent 
sneezings, and with a copious running at the nose. 
About noon I experienced a painful contraction of the 
back of the jaws, which made me fear an attack of 
tetanus. I went to bed, hoping that repose would 
alleviate my suffering, but it did not abate ; on the 
contrary, it continued nearly the whole of the follow- 
ing night, but I lost the contraction of the jaws about 
seven in the evening. The next day the pain left me. 
I continued to suffer for two days, and the pain re- 
turned when I put my hand into the water, and I did 
not finally lose it for nine days." Again, a species in 
Timor produces, as Yan Hasselt states, an erysipelatous 
dermatitis, with most intolerable pain, trismus, teta- 
nus, and death, in the same way as after extensive 
burns. According to other accounts, the sufferings 
may be protracted for a year. 

The nature of the poisonous principle contained in 
the glands of the Urticae has not yet been definitely 
determined. They have been reported to contain for- 
mic acid and carbonate of ammonia, but formic acid 
does not produce wheals when pricked into the skin, 



142 DERMATITIS VENENATA. 

nor the formidable class of symptoms attributed to 
the tropical species. 

Cases of poisoning by nettles rarely come to the 
physician for treatment in this country, probably be- 
cause the duration of the urticarial condition is so 
brief. I have never seen a case, with the exception of 
that upon my own hand. Possibly the family phy- 
sician in the country might have a wider experience 
in the treatment of the affection. Works on derma- 
tology offer only the briefest description, if any, of 
their effect upon the skin. Large quantities of some 
of the introduced species are gathered in some parts 
of the country for medicinal purposes, one dealer in 
North Carolina offering in a recent circular one thou- 
sand pounds for sale. The dried plants are harmless 
when handled. 

Treatment. — This may be very briefly considered. 
The duration of the effect of all the species growing in 
the United States upon the skin is short, never, so far 
as I know, exceeding twenty-four hours, and rarely 
more than two or three. In our ignorance of the 
nature of the active principle, it would be useless to 
discuss the action of antidotes. Probably the course 
of the erythema and urticarial efflorescence would be 
abbreviated, and the burning pain alleviated, by the 
application of evaporating lotions of alcohol and wa- 
ter. Possibly the addition of carbolic acid or laudanum 
would relieve more quickly the subjective symptoms. 



OTHEK IRRITANTS, 

ORGANIC AND INORGANIC. 



OTHEE IEEITANTS, 

ORGANIC AND INORGANIC. 



In this list is included a great variety of substances, 
many of which are among the most powerful cuta- 
neous irritants known. They are all capable of excit- 
ing a dermatitis by contact, although some of them 
may also produce a caustic action upon the skin. 

Saccharum. Sugar. 

The old-fashioned term " grocers itch" is rarely 
applicable in these days of refined and double-refined 
sugars. Formerly, when brown sugars were almost uni- 
versally used in the household, it was employed to sig- 
nify an eczema of frequent occurrence upon the hands of 
the grocer, who handled not only these, but many other 
substances belonging to his trade, which were more or 
less irritating to the skin. What share the sugar had 
in thus exciting the skin, it is impossible to say, but 
to it was attributed the greatest. These sugars often 
contained an abundance of mites, but it is improbable 
that they excited any irritation by contact. In sugar 
and candy manufactories a mild papular dermatitis 
of the hands and arms is not uncommon among the 
workmen; but we have here a very active cause of 
irritation of the skin in operation also, viz. direct 

10 



146 DERMATITIS VENENATA. 

heat and a general high temperature of the work- 
rooms. A mixture of brown sugar and salt, or sugar 
and salt pork, is often used to stimulate an inflam- 
mation of the skin. The inflammatory condition of 
the skin in diabetes may be directly due to the sugar 
circulating in its tissues. 

Oleum Terebinthinae. Oil of Turpentine. 

Oil or " spirits " of turpentine has long been used as 
an external application to produce counter irritation, 
or a rubefacient effect upon the skin. This is best 
accomplished by wringing out a flannel cloth in hot 
water, then saturating it with the turpentine and ap- 
plying it to the skin. In a few minutes great heat is 
felt in the part, soon transformed into smarting, which 
in fifteen or twenty minutes becomes almost unbear- 
able. On removing the cloth, the skin is then found 
to be of an intense uniform redness, which persists 
for several hours, and does not wholly fade out for 
two or three days. If such stupes be kept too long 
upon the skin, vesication may result. 

Applied simply to the skin turpentine may generally 
be used freely, even over extensive surfaces, without 
producing the slightest irritation. Thus in the treat- 
ment of tinea versicolor it may be rubbed over the 
whole trunk daily for an indefinite period without 
exciting the skin. 

The vapor of turpentine seems at times to be more 
stimulating to the skin than its direct contact. In sev- 
eral instances, mostly in women, I have seen an ecze- 
matous inflammation of the face, which I have referred 
to the frequent use of the oil in cleaning pallets and 
brushes, and in many cases I have seen repeated aggra- 



DERMATITIS VENENATA. 147 

vation of acne among young lady artists, which I 
ascribed to the same cause. 

Tar. Pix liquida. 

Oil of Cade. Oleum cadinum. 

These empyreumatic oleoresins, the former obtained 
by destructive distillation from the wood of our South- 
ern pines, the latter from the Juniperus oxycedrus of 
Southern Europe, and similar products from the birch 
and beech, may all be considered under the common 
name of tars. They all act alike upon the skin in 
health and disease. Useful as they all are when ap- 
plied externally in the treatment of several diseases of 
the skin, they frequently cause disturbance of its tis- 
sues from injudicious use, and in some persons cannot 
be employed at all in this way. As a rule, the skin in 
a state of acute inflammation is intolerant of their 
application except in a very dilute state, so that their 
chief usefulness in cutaneous therapeutics is in the 
chronic, especially the scaling stages of its inflam- 
matory affections. 

They are capable of exciting two forms of inflam- 
mation, even when applied to the skin largely diluted 
in the form of ointment, or solution. One is a dif- 
fused dermatitis, characterized by uniform thickening 
and redness of the area to which it has been applied, 
with much burning and itching, which subside slowly, 
and sometimes pass into an eczema of indefinite dura- 
tion. The other form is a well-marked acne-like in- 
flammation of the follicles, occurring as papules, and 
papulo-pustules, discrete or grouped, and variable in 
size. The mouths of the follicles are often strongly 
defined by a black stain or plug of dried tar, so that 



148 DERMATITIS VENENATA. 

both the tips of the inflamed glands, as well as those 
which remain unaffected, present the appearance of 
comedones. Sometimes the papules or pustules are 
surrounded by a well-marked halo of redness. This 
condition is called tar acne. It has been sometimes 
observed in workmen employed over machinery lubri- 
cated with tarry compounds, and under other condi- 
tions by which the atmosphere of working-rooms is 
impregnated with the vapor of tar. In some persons 
the comedo-like formations are extensively present 
when no folliculitis occurs. The affection generally 
disappears soon after the exciting cause ceases to act 
upon the skin. 

Creasotum. Oreasote. 

Since the introduction of carbolic acid into such 
frequent use in therapeutics, the employment of crea- 
sote as an application to the skin has become almost 
obsolete. Applied in an undiluted state it causes a 
considerable degree of reddening and irritation, and 
on parts denuded of epidermis it produces an imme- 
diate white appearance due to the coagulation of the 
albumen of the cutaneous fluids, with the formation 
of an eschar. Even upon the normal surface of the 
skin it may act as a caustic, when painted over it 
thoroughly or repeatedly. 

Acidum Carbolicum. Carbolic Acid, 

The application of undiluted carbolic acid to the 
skin produces an immediate burning sensation, fol- 
lowed by tingling and partial loss of sensibility. The 
part becomes at first white, and later remains of a 



DERMATITIS VENENATA. 149 

reddish brown tint for a considerable time. The sur- 
rounding integument is reddened, and a more or less 
intense dermatitis ensues beneath the superficial eschar 
thus formed, which may last for two or three weeks, 
marked by fluid and cell exudation, and the formation 
of sero-purulent or even hemorrhagic crusts. The 
action is at times purely caustic, but only superficial. 
It is on account of its superficial escharotic action 
that its application in a concentrated form to the skin 
in the vegetable parasitic affections is not advisable, 
as the eschar thus formed serves as an impenetrable 
shield to its continued action upon the plant life below 
it. At times it is described as producing a sort of 
mummification and death of the whole cutaneous tis- 
sues, when applied to a portion of integument for a 
considerable time. 

In such diluted states as are generally employed in 
cutaneous therapeutics, carbolic acid is capable of pro- 
ducing a decided irritation, an erythematous and pap- 
ular inflammation of the integument over wide areas, 
characterized often by a peculiar brownish hue, which 
may be sustained or excited to higher grades of der- 
matitis even, by continued use. By its injudicious 
use in this way, inflammatory affections of the skin 
are often prolonged or aggravated. 

In such extreme dilutions as are employed in sur- 
gical antiseptic sprays, dressings, and baths, too, car- 
bolic acid often irritates the skins of nurses and 
dressers, causing generally an erythema or a fine 
papular efflorescence upon the hands and arms, so 
much exposed to contact with them, identical in ap- 
pearance with ordinary eczema of the same grade. 



150 DERMATITIS VENENATA. 



Paraffin. 



Ogsten describes, according to Piffard, a condition 
of the skin of workmen engaged in working crude 
paraffin at Aberdeen, who are brought in contact with 
the shale and oily matters mixed with it. In the 
acute form, the hands, wrists, feet, and legs soon be- 
come covered with an eruption of bright red nodules, 
usually largest and most numerous on the wrist. 
The backs of the hands are most severely affected, 
while the palms and soles remain unaffected. The 
redness and induration, which are confined to the hair 
follicles, gradually diminish after a little time, and 
leave the follicle enlarged and its mouth dilated. In 
this way by successive invasion of this inflammatory 
process, the hair follicles of all workers in paraffin 
become enlarged and patent, so that the black dots 
in the skin strike the observer at once. This is 
more noticeable in persons with dark skins and coarse 
hair. 

In chronic and exaggerated cases, the backs of the 
hands and feet, fingers and toes included, exhibit a 
peculiar honeycombed appearance of the skin, which 
is elevated, thickened, and inelastic, so as to render 
flexion painful and difficult. This appearance is due 
to densely grouped clusters of hair follicles distended 
with accumulations of dry epithelial cells, so as to 
easily admit the entrance of a probe within their 
mouths. The hairs become atrophied and disappear, 
and cracks and bleeding fissures form in the affected 
parts. In some workmen these changes in the skin 
are so serious that they are obliged to give up the 
occupation. 



DERMATITIS VENENATA. 151 

Petroleum. Oleum Petrce. Bock Oil. 

According to the Dispensatory, the application of 
crude petroleum to the skin may produce eczematous 
eruptions, and Piffard quotes from Koehler the state- 
ment that workmen in petroleum suffer from a scar- 
latinoid eruption, or from furuncles upon exposed 
parts of the skin. 

On the other hand, I have seen teamsters, engaged 
in transporting the crude material from the railroad 
tank to the refining factories, wash their faces and 
hands in a bucket of the oil. For years I have used 
it for the destruction of scalp and pubic lice, directing 
it to be applied to the head and genital regions, and 
to be left in contact with the parts for hours at a 
time ; and although the skin is frequently greatly in- 
flamed in consequence of the presence of these para- 
sites, I have never seen the slightest evidence of any 
irritative action produced by its use. 

It may be that workmen in refineries suffer, as 
above stated, from contact with some of the very 
numerous products obtained by the various processes 
there employed, and not from the crude oil itself; 
but I am informed by the superintendent of one of 
the largest refineries in the country, that it is only 
very rarely that any irritation of the skin occurs 
among his workmen. This is noticed especially in 
hot weather, and among those only who have to do 
with the paraffin products. It consists of a mild 
degree of eczematous inflammation of the backs of 
the hands and forearms, which passes away rapidly 
after giving up the occupation. It affects but a small 
proportion of the workmen. It should be stated, 



152 DERMATITIS VENENATA. 

however, that the crude oils used in this establishment 
do not contain as large a percentage of paraffin as 
some others. 

Acidtim Pyrogalliciim. Pyrogallic Acid. 

This product of the sublimation of gallic acid, lately 
introduced into cutaneous therapeutics, and largely- 
discarded in turn on account of the fatal results which 
have followed its use in several instances when exten- 
sively applied to the skin, is capable also of producing 
an active local inflammation when used upon the in- 
tegument in ways not otherwise dangerous. 

It is frequently employed in the form of an oint- 
ment, powder, or mixed with gelatine or traumaticin, 
etc., for the destruction of morbid tissues in lupus and 
epithelioma. If an ointment, 3ss or 3j to 5j of lard 
or vaseline (smeared upon linen), be applied to an 
area of the disease and renewed morning and even- 
ing, it may be worn without much pain for twenty- 
four or thirty-six hours. Later it causes great smart- 
ing and burning, and if removed at this period it will 
be found that the healthy integument surrounding the 
disease in contact with the acid is often in a state 
of intense inflammation. The natural redness of the 
dermatitis is concealed by the blackening of the parts, 
due to the oxidation of the acid, but the epidermal 
layers are softened and elevated by the fluid exuda- 
tions beneath them, and on being cast off show a freely 
suppurating surface. A thick, dark crust is established, 
beneath which the process of repair takes place with a 
complete restoration of the normal skin. If the appli- 
cation be continued beyond the above periods for any 
considerable time, a deeper-seated inflammation may 



DERMATITIS VENENATA. 153 

ensue, resulting in a destruction or sloughing of the 
sound skin in direct contact with the preparation, and 
in a dermatitis of a milder grade affecting the sur- 
rounding integument to a considerable extent. The 
ulceration thus produced results, of course, in a per- 
manent cicatrix. 

It is stated in the Dispensatory, and by some writers 
on dermatology, that pyrogallic acid does not affect 
the healthy tissues when applied in this way for the 
destruction of the morbid growths in the affections 
above mentioned, but this is an error. Examples of 
its irritating action upon the normal integument are 
published in the " Journal of Cutaneous Diseases," for 
January, 1886, by Dr. C. W. Allen of New York. 

Acidum Salicylicum. Salicylic Acid. 

Salicylic acid as applied to the skin in diseased 
conditions, mostly in the form of ointment, cannot 
generally be borne beyond certain strengths without 
increasing any inflammation which may be present, 
or exciting it where it did not previously exist. Upon 
an inflamed surface, as in acute eczema, an ointment 
of 3ss to the ounce will often greatly aggravate the 
inflammation, and sometimes the skin will not tolerate 
one of more than gr. v. Upon non-inflamed surfaces 
3j to the ounce will generally be borne without 
injury, but occasionally this proportion will produce 
hyperemia, or even a papular dermatitis. 

Acidum Formicicum. Formic Acid. 

Concentrated formic acid applied to the skin pro- 
duces violent inflammation, severe burning pain, and 



154 DERMATITIS VENENATA. 

vesication, closely resembling the action of the Spanish 
fly. Its prolonged contact has caused sloughing. 

Acidum Picricum. Picric Acid. Carbazotic Acid. 

This acid, in addition to its powerful dyeing prop- 
erties upon the skin, is stated by Piffard, quoting 
Grange*, to be capable of producing also erythema, 
vesicles, and pustules. 

Chloral. Hydrate of Chloral. 

Chloral hydrate applied to the healthy skin pro- 
duces a sensation of heat and redness, and is stated by 
the Dispensatory to act as a powerful irritant upon 
wounded surfaces. Saturated aqueous solutions are 
said to have produced a vesicating and even caustic 
effect upon the skin. Used as an anti-pruritic in dilute 
alcoholic solutions, 3J to Oj, it is capable of creating 
a considerable degree of warmth and erythematous 
inflammation, and even a fine papular efflorescence, 
when sopped upon the skin two or three times a day. 
In the more concentrated form of camphorated chloral, 
consisting of equal parts of chloral and camphor 
rubbed together into a syrupy liquid, it produces 
intense burning pain for a short time, and often a 
brief dermatitis when applied to restricted areas, as in 
pruritus ani, but its irritative effects are disproportion- 
ately less than those of the weaker solutions above 
mentioned. 

The " Medical Press " (October 13, 1886) attributes 
vesicating properties to chloral hydrate. It recom- 
mends that it be spread in powder form upon adhesive 
plaster warmed over a gas jet until the chloral becomes 



DERMATITIS VENENATA. 155 

discolored and melted, and applied to the skin, which 
should be anointed beforehand with olive oil. It 
should be allowed to remain in contact with the skin 
for fifteen minutes, and it blisters without producing 
any unpleasant sensation. 

Chloroformum. Chloroform. 

Chloroform applied lightly to the skin produces a 
slight degree of redness. If used freely and in- 
cautiously, especially about the genital regions as a 
parasiticide in pediculosis pubis, it may produce an 
intense dermatitis, great redness and swelling, papules, 
vesication, etc. If evaporation be prevented after its 
application, it readily produces a blister. In the di- 
luted state in which it exists in the various liniments 
used for the relief of neuralgia, etc., it is capable of 
exciting redness, and even the formation of vesicles, if 
employed too freely. 

Acidum Sulphurosum. Sulphurous Acid. 

The officinal solution of sulphurous acid often pro- 
duces when applied to the skin, in the treatment of 
pruritus, the vegetable parasitic affections, etc., a 
considerable erythema and fine papular efforescence, so 
that its use has to be discontinued. 

Acidum Sulphuricum. Sulphuric Acid. 

In concentrated form, this acid destroys the cutane- 
ous tissues deeply, abstracting their watery elements, 
and carbonizing them. In the process of repair irregu- 
lar cicatrices are often formed, much hypertrophied, 
and causing great deformity and disfigurement. Its 



156 DERMATITIS VENENATA. 

action as a caustic in surgery, therefore, is not to be 
recommended. The diluted acid, sometimes employed 
in the treatment of skin diseases, and in the arts, is 
also capable of exciting the skin to a state of erythe- 
matous and papular inflammation. 

Acidum Nitricum. Nitric Acid. 

Applied gently to the skin in concentrated form, 
nitric acid changes it to a bright yellow color ; applied 
freely or rubbed into it forcibly with a sharply pointed 
stick, it causes the epidermis to swell and turn white, 
and forms an eschar, beneath which the process of re- 
pair is completed in ten days or a fortnight. As a 
caustic, thus employed, in the treatment of superficial 
epithelioma and other new growths of the skin, it 
holds a high rank, as its action is confined to the 
tissues to which it is applied. 

Acidum Hydrochloricum. Muriatic Acid. 

Hydrochloric acid and nitro-muriatic acid in con- 
centrated forms act as superficial caustics upon the 
skin, but less powerfully than nitric and sulphuric 
acids. Used in weak solutions, as baths and fomen- 
tations, they sometimes produce a general erythematous 
irritation, or a mild follicular inflammation. 

Ammonia. 

Aqua ammonise, if lightly applied to the skin, read- 
ily dissolves the epithelial layer, but if allowed to 
remain long in contact produces an erythematous or 
even vesicular inflammation. If the strongest or caus- 
tic preparation be applied to the skin upon lint it will 



DERMATITIS VENENATA. 157 

soon cause a blister, and later a deeper destruction or 
cauterization of its tissues. 

Concentrated solutions of carbonate of ammonia 
may excite a mild degree of inflammation. 

Potassa. 

Potassa applied to the skin rapidly destroys its tis- 
sues, so that it is often used as a quick cautery. The 
inflammation thus produced extends to a considerable 
extent beyond the borders of immediate contact, and 
downwards throughout all the cutaneous structures. 
Mixed with caustic lime, it forms the highly destruc- 
tive Vienna paste. 

Concentrated solutions, applied by compresses upon 
or rubbed into the skin, quickly dissolve the epithelial 
layers, and stimulate to resolution chronic inflamma- 
tory cell-infiltrations beneath. The dermatitis thus 
excited must be controlled by the immediate use of 
cold compresses and soothing ointments. 

Weaker solutions, and of the carbonate as well, as 
used in alkaline baths, may produce a general redness 
or fine papular eruption. 

But it is in certain employments that the irritating 
action of potash upon the skin is chiefly met with. 
Printers very frequently have an eczema of the hands 
excited by handling rollers and types which have been 
cleansed by potash. Soapmakers present all varieties 
of acute and chronic eczematous inflammation of the 
hands. Washwomen and others who use soft or pot- 
ash soaps frequently have hands which are dry and 
chapped, or may exhibit all grades of dermatitis. 
Sapo viridis is often a violent irritant of the skin, as 
injudiciously used in the treatment of its diseases. 



158 DERMATITIS VENENATA. 

Soda. 

The effects of caustic and concentrated solutions of 
soda are similar to those produced by potash, but soda 
soaps rarely produce more than a drying effect upon 
the skin when the alkali is in excess. 

Calx. 

The affinity of quicklime for the water of the tis- 
sues, and the great heat evolved by such union, make 
it an active caustic when applied to the skin. Its 
milder irritating properties are seen upon the hands 
of masons. 

Sodii Chloridum. Common Salt. 

Salt may be handled in its dry form without harm, 
but a concentrated solution of it applied to the skin is 
capable of exciting a papular efflorescence. The use 
of brine baths at certain health resorts also produces 
upon the surface of many persons a fine papular erup- 
tion of an eczematous character. The concentrated 
waters of our Great Salt Lake have produced similar 
results. I have seen not only these mild forms of 
inflammation upon the hands of pork packers, who 
handle moist salt and concentrated saline pickles, but 
also much more severe forms of dermatitis, impetigi- 
nous, furuncular, and ecthymatous lesions, and some- 
times diffused, deeper-seated inflammation. As such 
persons are often intemperate in their habits, and as 
other elements are present besides the salt, animal 
fluids of course, it is impossible to judge how exclu- 
sively the salt is the cause of the irritation ; but I have 
not met with just such appearances in workmen en- 
gaged in other occupations. The popular use of mix- 



DERMATITIS VENENATA. 159 

tures of moistened salt and sugar to stimulate the 
skin already in a state of inflammation, as over boils 
and abscesses, is well known. 

Sulphur. 

Sulphur, in nearly all the forms in which it has been 
for so long time applied to the skin, is capable of pro- 
ducing great irritation of its tissues. As an ointment, 
powder, wash, fumigation, or bath, it may cause an 
erythematous, papular, or vesicular inflammation, ac- 
cording to individuality of integument and duration 
of contact. Used, as it is so commonly, as a salve in 
the treatment of scabies and chronic affections of the 
skin, it often, if employed injudiciously, greatly aggra- 
vates the existing dermatosis. I have repeatedly seen 
the eczematous accompaniments of scabies aggravated 
and sustained for months by the continued use of this 
substance. It would have performed its serviceable 
duty as a parasiticide in three days ; its longer ap- 
plication becomes a perpetual irritant. I have often 
seen sulphur preparations convert a psoriasis into an 
active eczema, and their excessive use in acne often 
over-stimulates the skin of the face. A sulphur vapor 
bath may produce a universal erythematous or papular 
dermatitis of great intensity. 

Similar forms of cutaneous inflammation are excited 
by the combinations of sulphur and the alkalies, if 
employed without proper care ; the compounds chiefly 
used in the treatment of skin diseases being sulphide 
of potassium and Vlemingkx solution, a pentasulphide 
of calcium. Solutions or baths of the former may 
produce a papular or vesicular efflorescence, partly 
due, perhaps, to the action of the alkaline element, but 



160 DERMATITIS VENENATA. 

chiefly, without doubt, to the sulphur. The over free 
use of the Ylemingkx solution in the treatment of 
scabies, psoriasis, acne, etc., very readily excites an 
active inflammation, characterized by hyperemia, dry- 
ness, and chapping, or by swelling, and a fine papular 
eruption. Upon the most sensitive parts of the skin 
it may produce extensive excoriations, or the formation 
of vesicles. 

Iodine. 

Iodine is applied to the skin generally in the form 
of simple tincture, compound tincture, ethereal tinc- 
ture, or the more concentrated " iod-glycerine," made 
by rubbing up equal parts of iodine and iodide of pot- 
ash in glycerine. All these preparations, even slightly 
used, produce a reddish brown stain upon the skin, 
and some degree of redness and heat, followed by 
desquamation. Applied more thoroughly, especially 
the last two, they cause severe pain, and an inflamma- 
tion of the cutaneous tissues, amounting almost to a 
caustic action. The common custom of painting con- 
siderable areas of the skin with the simple tincture 
sometimes produces great swelling or " caking " of the 
integument, which is very painful, and may last for 
several days as an acute dermatitis. The epidermal 
structures are so altered and stiffened by the action of 
the iodine as to be unable to indicate this condition by 
the ordinary lesions, and the surface retains its flat- 
tened and even level. Occasionally, however, the in- 
flammation seems to be more concentrated within or 
surrounding the follicles, and an acneform efflorescence, 
papulo-pustular, appears, of considerable size, which per- 
sists after the more superficial and general dermatitis 
has subsided. 



DERMATITIS VENENATA. 161 

Iodoformum. Iodoform, 

The Dispensatory states that the application of 
iodoform to the sound skin and ulcers is not at all 
irritating, and, farther on, that it has excited a severe 
eczematous eruption. This substance is used with the 
greatest freedom as a dressing to wounds, ulcers, and 
denuded surfaces of all sorts, in dispensary and hos- 
pital practice, and generally, no doubt, without harm. 
On the other hand, it is very frequently the cause of 
inflammation of the healthy integument surrounding 
the seat of its application for such purposes. I have 
observed many cases of this nature, in which the in- 
flammation, starting up in the immediate vicinity of 
the ulcer or wound, has spread from it as a centre 
over extensive areas of skin. The character of the 
dermatitis is generally eczematous, resembling eczema 
erythematosum and papulosum. The skin is uni- 
formly red, swollen, and thickly occupied by minute 
papules, which become excoriated at points, and dis- 
charge serum without passing into the vesicular stage. 
Occasionally more intense grades of inflammation are 
produced, indicated by great oedema, by abundant ve- 
siculation, and by the formation of large bullae. Such 
effects are more likely to occur when iodoform is ap- 
plied to the scalp or its vicinity, and are very threaten- 
ing in appearance for a time. The inflammation may 
persist as an ordinary eczema long after the exciting 
cause has ceased to act. Sometimes the dermatitis 
may be produced upon parts remote from the original 
sore by the accidental or careless scattering of the 
powder upon such distant parts during treatment, or 
by its too profuse application over a large extent of 

surface surrounding a wound, either by the attendant, 

11 



162 DERMATITIS VENENATA. 

or by loosely adjusted dressings. Such results more 
commonly follow its use in the form of powder. 

Cutler in his paper on iodoform poisoning (Boston 
Medical and Surgical Journal, July 29, 1886) refers to 
several cases of dermatitis produced by its application 
to the skin. 

Bromum. Bromine, 

Bromine is a powerful corrosive irritant of the skin, 
producing rapid cauterization of its tissues in its con- 
centrated form, and at times gangrenous sores. Its 
action upon wounds for the destruction of unhealthy 
tissue is well known, and is extremely painful. 

Chlonim. Chlorine, 

Chlorine gas acts as an irritant upon the skin, pro- 
ducing prickling and redness when held in contact 
with it, and sometimes an eruption of papules and 
vesicles. Its solution in water, aqua chlori, has some- 
• times produced an irritation of the skin also. Chlori- 
nated soda and chlorinated lime solutions occasionally 
cause a mild degree of inflammation, erythematous 
and papular in character, in workmen employed in 
bleacheries, paper-mills, etc. 

Arsenicum. Arsenic, 

Various preparations of arsenic are the frequent 
cause of dermatitis, owing to their large use in the 
arts. As pigments, in the preparation of wall and 
other colored papers, in printed and dyed cloths for 
garments and artificial flowers, in combination with 
aniline and other dyes, as preservatives of sizings and 
pastes, for curing hides and bird skins, etc., they are 



DERMATITIS VENENATA. 163 

used in vast quantities, and the workmen employed in 
manufacturing and those manipulating these products 
are subject to a great variety of inflammatory pro- 
cesses of the skin. 

The action of arsenical compounds upon the skin 
was studied by Bazin experimentally, by rubbing them 
repeatedly into it. The mildest grade of inflammation 
produced is an erythema, which is diffused, and upon 
which, later, small papules may develop, which in- 
crease in size, or fine transparent vesicles and pustules 
may arise. The last are conical, with a red base, and 
rapidly become purulent at their tips and covered with 
yellow crusts. By further contact with the arsenic 
the pustule is converted into a characteristic ulcer, 
which is round, with a grayish or reddish moist base, 
and is sometimes surrounded by a dense induration. 
It may penetrate the cutaneous tissues deeply, and is 
generally painful. Such, too, are the lesions which 
affect the workmen employed in the arts in which ar- 
senical compounds are freely used. Their most com- 
mon seat is the hands, especially about the nails, and 
the forearms, parts which come directly in contact 
with the arsenic. They frequently affect also the face, 
especially the regions of the lips and nose, behind the 
ears about the neck, the scrotum and surfaces of the 
thighs adjoining, and the toes. 1 

The following cases will illustrate various grades of 
dermatitis. 

Case I. — I was called to see a baby two months old 
which was receiving nourishment from a wet nurse, 

1 See article on Arsenical Eruptions, by Prince A. Morrow, M.D., 
in Journal of Cutaneous and Venereal Diseases, July, 1886. 



164 DERMATITIS VENENATA. 

and was plump and of healthy appearance. During 
the preceding week there had developed a papular 
eruption upon the cheeks, and a slight intertrigo behind 
the ears and in the folds of the neck. In spite of the 
treatment advised, the disease increased rapidly in ex- 
tent and severity, the whole face presenting within 
ten days a papular efflorescence of vivid redness, con- 
fluent and excoriated, while a considerable portion of 
the scalp was affected in the same way. Upon the 
neck the opposing surfaces of the integument within 
the deep folds were intensely reddened and excoriated 
at their juncture, at the bottom of the furrows. In the 
folds of the axillae, in the groins, and in several of the 
deep folds on the inner surface of the thighs, the skin 
presented the same intense grade of intertrigo. Upon 
the lower legs there was an eczematous papular efflores- 
cence. I continued to treat the child from December 
1st to February 6th without being able to control the 
inflammation at all. After the first two or three 
weeks the child's digestion became disturbed, and the 
stools assumed a bright green color and were over fre- 
quent. It ceased to gain in weight also. The wet 
nurse was changed twice, the second one because she 
had several attacks of acute indigestion ; but with the 
third one, a florid, healthy woman in all respects, 
no improvement in the child's condition took place. 
On this latter date, February 6th, the wall-paper upon 
the child's room attracted my attention, (the baby had 
until then been brought down-stairs at my visits,) and 
on analysis it was found to be highly arsenical. It 
was an old French paper, and the pigments were loosely 
laid on. The patient was removed to another room, 
and an immediate change in the child took place. 



DERMATITIS VENENATA. 165 

The intestinal discharges became less frequent, and 
after a few days lost their green color ; the intertrigo 
became at once less red and moist ; and there was a 
gain during the first week of three quarters of a pound 
in weight. At the end of the second week another 
pound had been gained, the diarrhoea had wholly 
ceased, the intertrigo had disappeared from all parts, 
and there was only a little dry and scaly eczema left 
upon the cheeks. All these rapid changes ensued with- 
out any alteration in the treatment employed. The 
development of the dermatosis in this case ten days 
after beginning to occupy the arsenical chamber, the 
very unusual area of intertriginous inflammation in 
the winter season, its extraordinary resistance to treat- 
ment, and its immediate recovery on removal to an- 
other room, with the other symptoms, leave no doubt 
in my mind that it was an example of arsenical 
dermatitis. 

Case II. — A few years ago a student consulted me 
with regard to his hands. The palmar surfaces were 
universally occupied by vesicles buried deeply beneath 
the thick horny layer, as closely approximated as pos- 
sible without becoming confluent, and varying in size 
from a large pin's head to a medium-sized pea. They 
presented with their semi-translucent coverings that 
peculiar boiled-sago-like appearance considered to be 
characteristic of so-called dysidrosis. The pressure of 
the imprisoned fluid produced but a slight bulging of 
the cuticle overlying the individual efflorescences, but 
towards the lateral surfaces of the fingers the lesions 
became more prominent, and in the more yielding 
epidermis between them well-developed elevated vesi- 
cles. There was considerable general thickening of 



166 DERMATITIS VENENATA. 

the integument, with much burning and itching. All 
these manifestations of an acute dermatitis reached 
their height of development in three or four days, and 
subsided in the course of the following week, leaving 
a somewhat prolonged desquamation of the palms, cor- 
responding to the depressed roofs of the vesicles in 
their stage of involution, none of which had been able 
to discharge their fluid contents. The patient had 
been using a few evenings before the beginning of the 
inflammation a pack of playing cards, the backs of 
which were printed with arsenical green. 

Some years after this attack the same patient, then 
Dr. X., of the staff of the Massachusetts General Hos- 
pital, showed me his hands again in a state of acute 
dermatitis, of which he kindly furnishes the following 
account. A few days after papering a screen with some 
wall-paper, after the manner of paper-hangers, i. e. 
moistening the paper with paste and laying it upon 
the frame and brushing the colored side until it be- 
came smooth, a number of fine papules appeared in 
groups upon the dorsum of the fingers of each hand. 
In twenty-four hours they had increased rapidly, and 
were accompanied by burning and tingling. Many of 
the papules coalesced and formed vesicles. The hands 
were swollen and painful, and the inflammation ex- 
tended to the lower forearms. New efflorescences 
appeared for several days, and the attack lasted some 
ten days. A piece of the paper was examined by Dr. 
Charles Harrington, who reported that it was " loaded 
with arsenic," and was one of the worst samples he 
had ever seen. 

Case III. — On the 19th of the month my opinion 
was asked concerning a patient applying for readmis- 



DERMATITIS VENENATA. 167 

sion to the Massachusetts General Hospital, from which 
he had been discharged " well " twelve days previously, 
after five weeks' residence on account of " anaemia and 
general debility." He had been at work for a week, 
but for two days his mouth had felt sore, and he had no- 
ticed red spots upon his hands and forearms. When 
I saw him, these parts were swollen, and presented nu- 
merous erythematous patches, which in some parts 
had already passed into papular forms of inflammation. 
His face was very red and greatly swollen, so that his 
eyes were nearly closed. The ears were of nearly dou- 
ble their natural thickness, and were discharging serum. 
The oedema and redness extended downwards upon 
the neck as far as it was exposed to view only. There 
was also serous oozing and crust formation upon the 
chin. It was evidently a case of severe artificial der- 
matitis. On the following day, the 20th, the face 
presented a more general incrustation, and there was 
free oozing of serum from its surface. The eyes could 
be partially opened. On the 21st, the skin of the face 
and neck remained as before, but the backs of the 
hands and forearms were covered with serous and sero- 
purulent vesicles. On the 22d, the face was still more 
crusted, and the hair was falling in great quantity 
from the whole scalp. On the 23d, the vesicles upon 
the hands and forearms had increased greatly in num- 
ber and size, and by confluence some groups had been 
converted into large, prominent bullae. There was 
some oozing from these parts, and crusts were begin- 
ning to form upon them. In the evening the patient's 
condition had become greatly exaggerated. The face 
was so swollen that it seemed ready to burst, and, in- 
deed, was discharging serum profusely from numerous 



168 DERMATITIS VENENATA. 

points. The eyes were entirely concealed. The hands 
and arms were of enormous size, and were also drip- 
ping freely. The temperature had risen to 102.5° F. 
The pulse was 100. The patient appeared to be in a 
very dull mental condition, and made but little com- 
plaint. On the following morning, the 24th, there was 
a free general sero-purulent exudation from the face, 
and the temperature rose again in the evening, but 
only to 101° F. From this time the inflammation of 
the skin slowly subsided. On the 28th, the eyes could 
be opened, and the face was nearly free from crusts. 
On the 7th of the following month the patient was 
discharged, although the skin of the parts affected 
was still reddened and desquamating. It was learned 
during his illness that he had been engaged for three 
days previous to the appearance of the cutaneous 
symptoms in fastening pieces of white webbing into 
sample books, the paper linings of which, as deter- 
mined by chemical analysis, were covered with green 
arsenical pigment. 

Arsenical preparations are used purposely for the 
destruction of cutaneous tissues. Their action varies 
from that of a simple depilatory to that of a caustic 
of deep penetration. They may give rise to gangrene, 
and have produced fatal results by absorption. 

The following list of articles in which arsenical pig- 
ments, dyes, or mordants are used is found in the 
article by Professor Wood in the report of the Massa- 
chusetts Board of Health for 1884 on "Arsenic as a 
Domestic Poison " : — 

Paper, fancy and surface-colored ; in sheets ; for cov- 
ering card-board boxes ; for labels of all kinds ; for 
advertising cards ; for playing cards ; for wrappers 



DERMATITIS VENENATA. 169 

and cases for sweetmeats, cosaques, etc. ; for the orna- 
mentation of children's toys ; for covering children's 
and other hooks ; for lamp-shades ; paper hangings for 
walls and other purposes ; printed or woven fabrics 
intended for use as curtains or covering for furniture ; 
printed or woven fabrics, intended for use as gar- 
ments ; children's toys, particularly inflated india-rub- 
ber balls with dry color inside ; painted india-rubber 
dolls, stands and rockers of rocking-horses, and the 
like ; glass balls (hollow) ; distemper color for deco- 
rative purposes ; oil paint for the same ; lithographic 
color printing ; decorated tin plates, including painted 
labels used by butchers and others to advertise the 
price of provisions ; japanned goods generally ; Vene- 
tian and other blinds ; American or leather cloth ; 
printed table baizes ; carpets ; floor-cloth ; linoleum ; 
book-cloth and fancy bindings. 

Hydrargyrum. Mercurial Preparations. 

Mercury and its compounds are used upon the skin 
in the form of ointments, lotions, baths, and fumiga- 
tions ; and in all such forms it is capable of producing 
dermatitis in varying degrees of intensity. The prep- 
arations most commonly employed with such results 
are unguentum hydrargyri, ung. hydrarg. amnion., 
liquor hydrarg. nitratis, and solutions of hydrarg. 
chlorid. corrosiv. 

Mercurial ointment, as employed in the inunction 
cure of syphilis, where it is rubbed into considerable 
areas of the skin for several minutes — ten to twenty 
— at a time, and for months consecutively, is ordi- 
narily borne without producing noticeable irritation. 
In exceptional cases, however, especially in the hot 



170 DERMATITIS VENENATA. 

season, it causes an inflammation of the seat of friction, 
characterized by diffused erythema, by an abundant 
eruption of papules, which rarely pass into vesicles, 
or by simple hyper semia of the follicles. 

White precipitate ointment is a more active irritant 
than the above, as generally used upon the skin in 
a state of disease. If applied, in the strength of a 
drachm to the ounce of lard, to an eczematous sur- 
face, for instance, it often aggravates the existing 
dermatitis, or changes a chronic state of inflammation 
into an acute one. 

Nitrate of mercury or citrine ointment is still 
more irritating, and often causes a decided dermatitis, 
redness, swelling, papules, and vesicles, when inju- 
diciously applied to the skin in the treatment of its 
inflammatory and non-inflammatory affections. The 
liquor hydrargyri nitratis is a powerful caustic when 
applied to the skin, causing a yellow coagulation and 
crust, and producing severe inflammation of the cuta- 
neous tissues surrounding the point of application. 
Its local action closely resembles that of nitric acid, 
and in fact is largely due to the presence of the latter 
in an uncombined state. 

Corrosive sublimate may be applied to the skin in 
aqueous solutions of one grain to the ounce, generally 
without irritation, upon surfaces even somewhat in- 
flamed. Stronger solutions must be used cautiously, 
and frequently produce erythematous, papular, and 
vesicular inflammation when applied as lotions even 
to the sound skin. The use of the antiseptic solu- 
tions, dilute as they are, in the form of spray and 
bath, not unfrequently excite a mild degree of derma- 
titis, erythematous and papular, of the hands and 
arms of surgical dressers and attendants. 



DERMATITIS VENENATA. 171 

Antimonii et Potassii Tartras. Tartar Emetic. 

Solutions of this double salt applied to the skin 
produce a variable degree of redness and superficial 
irritation according to their concentration, but mixed 
with fat it gives rise to deep and intense dermatitis of 
long duration ; the lesions are at first papular, rapidly 
changing to vesico-pustules, which increase in size 
and closely resemble the eruption in variola with the 
exception of not being umbilicated. They are seen 
and felt to be deeply seated, and are surrounded by 
a considerable hyperaemia. The pustules are fully 
formed in four or five days, and terminate in thick 
crusts, or in open ulcers, which heal very slowly and 
often leave permanent scars. Sometimes deep sloughs 
are formed, resulting in disfiguring cicatrices. 

Salts of antimony (chloride) are often used as a 
mordant in process of dyeing, and frequently pro- 
duce upon the hands and forearms of workmen, who 
handle the fabrics moistened by them, a violent der- 
matitis, resembling papular, oozing, and pustular 
eczema. Such cases may arise, therefore, where the 
pigments themselves employed in the dye-house are 
perfectly harmless. 

Argenti Nitras. Nitrate of Silver. Lunar Caustic. 

It is on account of the failure of nitrate of silver to 
produce dermatitis that its use in cutaneous surgery 
is so general and valuable. This negative property is 
no doubt due to the rapid affinity of the silver salt 
for albumen, which is instantly coagulated, forming 
a firm shield, which prevents the extension of the 
caustic action beyond the immediate point of contact 



172 DERMATITIS VENENATA. 

with the tissues. On this account the fused stick of 
caustic may be bored deeply into softening diseased 
tissues, like lupus, without producing more than a 
slight redness and swelling of the surrounding and 
healthy integument, which subside within a few 
hours or days. Applied to the healthy skin in a moist 
state, it produces a white stain, which soon becomes 
gray and later black, but, if gently used, no inflam- 
matory action. If it be rubbed violently into the 
sound skin for a considerable time, it may possibly 
produce vesication and a superficial eschar ; but this 
is not followed by the formation of a scar. 

Zinci Chloridum. Chloride of Zinc. 

Chloride of zinc, through its strong affinity for 
water, acts as a powerful corrosive caustic upon the 
cutaneous tissues, producing a mummifying action 
upon those with which it comes in contact, and a 
considerable inflammation in those surrounding, with 
great pain. These properties have brought it into 
frequent use for the destruction of morbid growths of 
the skin. Fatal results through absorption have fol- 
lowed its application to the lip. 

Acidum Chromicum. Chromic Acid. 

Chromic acid, in an undiluted form, acts as a pow- 
erful and rapid caustic upon the skin, forming a black 
eschar, and leaving a superficial granulating surface. 
Upon workmen engaged in its manufacture or use, it 
frequently causes intense dermatitis of the hands and 
arms, and bad ulcers. Its use in surgery for the 
destruction of excrescences and new growths of the 
cutaneous tissues is well known. 



DERMATITIS VENENATA. 173 

Potassii Bichromas. Bichromate of Potash, 

In combination with potash, chromic acid is still a 
powerful irritant of the skin. Applied in concen- 
trated form to cutaneous growths, it destroys them ; 
but its action is less violent than that of the free 
acid. Its dust, inhaled, produces destructive ulcera- 
tion of the nasal mucous membrane. Strong solutions 
applied frequently or habitually to the skin produce 
an eruption of papules and pustules, and later deep 
sloughs and ulcers. Thus workmen who employ it 
in their arts — dyers, electricians, photographers, etc. 
— are liable to deep and painful ulcers on the hands 
and arms. Recently attention has been called to its 
irritative action upon the skin in wearing apparel. 
Dr. Harrington (Boston Medical and Surgical Journal, 
August 12, 1886) has published an important paper 
upon this subject. He finds that chrome mordants 
are used in the production of brown, brownish red, 
claret-red, olive, yellow, old gold, purple, buff, gray, 
and black dyes. He cites the case of a capmaker, 
who, after cutting up a piece of dark blue cloth for 
boys' caps, experienced in a few days an intense itch- 
ing of her scalp, face, neck, and hands. Later the 
itching became general, and sores appeared upon the 
neck, breast, thighs, and hands. The ears were swol- 
len and oozing. After sewing the caps, the fingers 
became swollen and very painful, and ulcerations 
about the nails developed, resulting in the loss of 
three nails. Poisoning was suspected, and an analy- 
sis of the cloth demonstrated the presence of a large 
amount of chromium. The work was discontinued, 
and in a short time the cutaneous symptoms disap- 



174 DERMATITIS VENENATA. 

peared. Two years afterwards she spent some time 
in dusting and packing away the same unmade caps, 
and on the following day her hands again became 
sore, especially the nails, and one of the latter "came 
away." Another case was that of a clergyman, who, 
after wearing for three or four days a pair of newly 
purchased brown woollen mixed gloves, noticed a 
redness and irritation of hands and wrists. He con- 
tinued to wear them, however, for a few days longer, 
until he noticed that the increasing inflammation 
ceased abruptly at the line where the gloves ceased to 
come in contact with the wrists. Then they were 
laid aside, and a subsequent examination showed the 
presence of a large amount of chromium, and the ab- 
sence of arsenic and antimony. The eruption was " at 
first in the form of pimples, but afterwards many of 
them ran together and became blotches.' ' Later, con- 
siderable ulceration occurred, and at the end of some 
two months the large and deep ulcers had healed. 

I have seen several cases of deep-seated dermatitis 
produced by gloves and stockings of quiet colors which 
may have been due to the presence of chrome mor- 
dants. The presence of chromium compounds was not 
ascertained because not looked for ; but the absence 
of arsenic in the fabrics was determined in several of 
the cases. 

Cases of irritation by this substance are so common 
among photographers that the affection has recently 
been described by Dr. B. W. Richardson, of London, 
as " the bichromate disease." It begins with a vio- 
lent irritation between the fingers, and spreads over 
the hands and wrists. The solution of bichromate 
employed in the carbon process is one part in twenty 



DERMATITIS VENENATA. 175 

of water. Persons whose skin is thus affected are 
obliged to work with rubber gloves. 

Platini Chloridum. Chloride of Platinum, 

Strong solutions of the perchloride of platinum act 
as an irritant upon the skin, producing an eruption of 
papules. In concentrated form it causes the forma- 
tion of a yellowish white eschar, with great redness of 
the surrounding tissues. 

Poisonous Clothing. 

Formerly cases of dermatitis from articles of wear- 
ing apparel were mostly produced by dresses or veils 
of brilliant colors readily recognized to be arsenical 
dyes, as green tarlatans, etc., and instances of this 
nature still occasionally occur ; but in the past twenty- 
five years, since the discovery of the aniline pigments 
and new processes of developing and fixing colors by 
mineral mordants, the poisonous nature of clothing 
has immensely increased, and can be no longer recog- 
nized or suspected by its tints. The great variety of 
brilliant dyes made from aniline or coal tar are largely 
produced by the agencies of such powerful irritants as 
compounds of arsenic, mercury, and chromium, and 
often contain traces or considerable quantities of 
these substances when employed in the arts. In the 
processes of mordanting and printing too, chromium, 
antimony, and arsenic are used in great quantities, 
and remain in the fabrics as possible sources of irri- 
tation. In some instances where arseniate of alumina 
has been employed as a substitute for albumen, twenty 
grains of arsenious acid have been extracted from a 
single yard of calico. It is not surprising, therefore, 



176 DERMATITIS VENENATA. 

that workmen engaged in dyeing and handling such 
cloths, milliners and dress-makers who make them 
up, and those finally who wear garments made from 
them, should suffer from contact with them. The 
most common sources of such forms of dermatitis are 
colored undershirts and drawers, socks, and gloves, 
garments which are worn in long and close contact 
with the skin, but hat linings and shoe linings also 
occasionally produce similar results. Paper collars 
and cuffs have also caused inflammations of the skin 
from the presence of arsenic in the sizing employed in 
their finish or glaze. Less frequently, outer garments, 
both thin and heavy fabrics, have given rise to similar 
cutaneous disturbances. It is not the brilliant red 
dyes alone which are dangerous ; the most quiet colors 
may be equally so. I once treated a case of intense 
bullous dermatitis of the feet in parallel lines with 
interspaces of healthy skin. On comparing these 
markings with the stockings, which were colored in 
alternate stripes of scarlet and brown, it was found 
that the bands of inflammation corresponded to the 
brown dye. 

The nature of the dermatitis produced by such 
poisonous articles of clothing varies from simple 
hyperemia, papulation, vesiculation, or pustulation 
to excoriations and ulcerations, and according to the 
part affected, the duration of contact, and individual 
susceptibility. The particular form of inflammation 
is of course determined also by the nature of the poison 
in the dye ; but as these are generally preparations 
of arsenic, antimony, or chromium, their effects have 
already been described sufficiently in detail in the 
accounts of these substances respectively. Some cases 



DERMATITIS VENENATA. 177 

of unmistakable poisoning of the skin by clothing do 
occur, however, in which none of these substances are 
present, and in which the irritating element cannot 
be recognized by chemical tests. The diagnosis of 
these cases of dermatitis is simplified by the abrupt 
lines of demarcation, in most cases, between the in- 
flamed and healthy areas of skin, the limitation of 
the process to regions which fit certain articles of 
clothing worn in direct contact with them, and the 
intensity and sudden development of the inflamma- 
tion. The skin is, moreover, generally more uni- 
formly affected than in other dermatoses with which 
it might be confounded. 

Electricity. 

The application of electrical currents to the skin is 
capable of creating all degrees of excitement, inflam- 
mation, and destruction of its tissues, according to 
their strength, nature of electrode, etc. When applied 
in a diffused form over considerable areas, a slight 
degree of prickling, heat, and redness only are pro- 
duced. If more condensed or longer sustained, con- 
tact with electrodes, even when covered with wetted 
cloth, may produce wheals, erythema, and papules of 
rapid formation, which may subsequently develop into 
vesicles, pustules, or even slowly healing ulcers. The 
application of the electrolytic needle to the skin pro- 
duces an immediate decomposition of its fluids at the 
negative pole, with the destruction of the tissues with 
which it is in contact. When employed in the opera- 
tion for hypertrichosis, in which the needle is intro- 
duced to the bottom of the hair follicle, a red papule 
arises immediately, often capped by a crust, which 

12 



178 DERMATITIS VENENATA. 

sinks down in a day or two, and leaves a slight red 
point, which may remain for one or more weeks, and 
occasionally a minute white depressed scar, to mark 
the seat of the former follicle. If the needle be in- 
serted into several adjoining follicles in succession, the 
dermatitis excited is much more violent, expressed by 
the formation of large papules or tubercles covered 
with serous or hemorrhagic crusts, and permanently 
by large disfiguring scars. The insertion of the posi- 
tive pole produces a charring, carbonizing action up- 
on the tissues. When employed in the form of the 
thermo-cautery, the destructive effect upon the skin 
and the after action depend upon the degree of heat 
to which the electrode is raised. At the temperature 
of redness the subsequent inflammation of the tissues 
is generally more diffused and extensive than that 
which follows the more rapidly destructive action of 
the cautery at white heat. 



ANIMAL IRRITANTS. 



ANIMAL IRRITANTS. 



A work on Dermatitis Venenata should contain at 
least a brief account of the action of certain of the 
lower animals upon the skin. 

The number of these which are capable of producing 
some degree of inflammation in the cutaneous tissues 
by biting, stinging, or by mere surface contact, is con- 
siderable. It is excited in almost all cases by the 
insertion into the skin of some irritating substance, 
the nature of which is mostly unknown, connected with 
the mouth, mandibles, proboscis, etc., by means of 
special stinging organs situated elsewhere, or by the 
mechanical action of hairs, bristles, and the like. As 
with the vegetable irritants, the skins of all persons 
are not affected in the same degree by such agencies, 
and there is reason to believe that the cutaneous tis- 
sues acquire a protection against some of these animal 
poisons by repeated inoculation. I reproduce here, in 
substance, a communication published some years ago 
upon this subject. 

The law of more or less permanent and perfect protection 
against the subsequent action of many morbific agencies after 
primary inoculation is well recognized, although in no degree 
satisfactorily understood. The infrequent recurrence of the 
exanthemata in the same individual, the great immunity of 



182 DERMATITIS VENENATA. 

variolized persons from a repetition of the process, the still 
rarer repetition of syphilis, so rare that its possibility was long 
denied, the accepted theory of the influence of acclimatization, 
so called, over the action of miasmata, are sufficiently obvious 
illustrations of it. Perhaps, too, the protection against the 
toxical action of many of the mineral and vegetable poisons, 
gained by long-continued and gradually increasing doses, may 
be mentioned as a pertinent example of the same law, though 
less permanent in effect than in the instances first mentioned. 

The tissues and fluids of venomous snakes, as far as can be 
estimated by our capabilities of discernment, are identical with 
those of harmless species ; yet a small glandular arrangement 
of their tissues can make from these innocuous fluids a poison 
in swiftness and intensity of action equalling the most deadly 
of those produced by the chemistry of the laboratory or vegeta- 
ble kingdom. Now, strange to say, experiments conducted by 
most careful observers have demonstrated that this poison, so 
universally fatal to warm-blooded animals and all harmless 
serpents, when injected naturally and directly by the fangs, 
or artificially by the syringe, into the blood and tissues of the 
serpents producing it, or other individuals of the same or even 
allied species, produces but slight or no poisonous effect what- 
ever. " It is fairly to be concluded," Dr. Fayrer writes, " that 
the cobra is not affected by the poison either of the daboia or 
of its own species ; " and with regard to our own native poison- 
ous serpent, the rattlesnake, Dr. S. Weir Mitchell records ex- 
periments proving that it " is not susceptible of being injured 
by the venom of its own species." How can we explain this 
immunity except by reference to this mysterious law of pro- 
tection through self-inoculation, accomplished by the gradual 
absorption through life of minute quantities of virus ? To the 
toxical action of all other poisons the same tissues are most 
delicately susceptible, as much so as those of the non-venomous 
serpents. 

Whether man or other animals can be protected against in- 
jury from them by inoculation with their virus in quantities 
too small to produce serious results, or whether a person once 



DERMATITIS VENENATA. 183 

bitten and escaping death is no longer susceptible of injury 
from them, are questions of great interest in this connection ; 
but I can find no reliable data, founded on experiment, upon 
which they can be answered. I am permitted, however, to 
give an extract from a note by Professor Jeffries Wyman per- 
taining to the subject : " I have received your note with refer- 
ence to poisonous snakes. I know of no good evidence that 
man is rendered less susceptible to their poisons by inoculation. 
When in Surinam I was assured by Dr. Craigin, a very intel- 
ligent and careful observer, that the negroes there practised 
inoculation, and were rendered safe thereby. He stated that 
such persons were employed to hunt venomous snakes that 
had found their way into houses, and that they handled the 
snakes with impunity. I always felt, however, that there was 
a defect in the evidence, and did not consider the assertion 
bien constate!' This assertion of Dr. Craigin at least indicates 
the existence of a popular belief in the effective protection of 
inoculation. 

But the animal poisons which now concern us are not of this 
grave kind, and their action upon the human tissues is limited 
to the immediate vicinity of the point of insertion in most 
cases. It is only by the multiplication of these individual 
points, and over considerable areas of surface, that effects in 
any way serious are produced. We have all had ample oppor- 
tunity for personal study of the ordinary appearances produced 
upon the skin by the bite of a mosquito, flea, or that other and 
vile insect which shares with them their love of human blood. 
The prick of a lancet or needle, which draws the same quantity 
of fluid that they extract, produces but a momentary sensation 
of pain, and the minute wound closes by the elasticity of the 
tissues, or by the plastic elements which exude, and there the 
process ends. Not so with the lesion produced by these in- 
sects. There is first perceived a sensation of heat or itching in 
the part, and the hand is half involuntarily directed to the 
relief of the telltale nerve, although not always referred to the 
centre of sensation at once, so that a large portion of the con- 
tiguous skin is often rubbed or scratched before the right spot 



184 DERMATITIS VENENATA. 

is reached and temporary ease thus obtained. On looking, we 
see somewhere about the middle of the region we have been at 
work upon, and standing up in bold contrast to the reddened 
surface around it, a white and flattened prominence of irreg- 
ularly circular outline and hard, brawny feel, which increases 
in size according to the amount of original irritation, external 
friction, and individual temperament, and finally flattens down 
and disappears, leaving behind only in some cases a minute 
spot or depression, indicating the point of insertion of the 
poison. This is the ordinary effect of its introduction, although 
there are persons fortunate enough to be possessed of envelopes 
either so much like leather, or so blunted in sensibility, or so 
little to the taste of these insects, as to be uninjured by their 
attacks. There are those, on the other hand, on whom these 
appearances are greatly exaggerated, or who exhibit in the 
course of twenty-four hours a repetition of the same process, 
as if the poison had renewed its activity, or in whom the effects 
are not confined to the immediate locality of the bite, but ex- 
tend to large portions of the neighboring tissues, and cause 
great oedema and inflammation. 

But under peculiar conditions quite different and much more 
serious lesions of the skin are produced by the bites of all these 
insects. 

A family consisting of parents and four children, the latter 
between six and eighteen years of age, came to the Skin De- 
partment of the Massachusetts General Hospital for advice. 
The father and mother presented upon their faces, necks, fore- 
arms, and hands a very abundant outbreak of large and small 
papules, more or less prominent and mostly excoriated, among 
which were a few wheals and large vesicles. In the children, in 
addition to these forms of efflorescence, the whole skin of these 
parts was in an erythematous condition, and in the older two 
there were numerous pustular and furuncular, almost ecthy- 
matous lesions. It was in the youngest two children, however, 
that the climax of the disturbance was developed ; for upon 
them the process of free exudation was carried to its extreme 
limit in the form of very large bullae, which were so generally 



DERMATITIS VENENATA. 185 

distributed upon the regions above named as to give a pre- 
dominant character to the whole efflorescence and constitute 
an apparent pemphigus of extreme grade. Some of these blebs 
upon the arm of the boy were more than three inches long, 
and contained more than half an ounce of fluid. No better 
illustrations of the progressive passage of one form of well- 
defined efflorescence into another, from erythematous spot, 
through papule, vesicle, pustule, to furuncle, or from wheal to 
bleb, and of the insufficient basis their halting stages alone 
afford for the establishment of distinct titles in nosology could 
be desired. Yet this great diversity of appearances, embracing 
nearly every form of acute cutaneous lesion recognized, was 
produced by one and the same exciting cause in all the cases, 
viz. the bites of mosquitos. The differences presented by the 
various individuals of the family were such as are consistent 
with the well-known greater tendency to exudation in inflam- 
matory processes of the skin in childhood than in the same 
affections in adult life. The subjective symptoms in all were 
only slight itching, and the soreness necessarily consequent 
upon the gravity of the lesions. There was no constitutional 
disturbance. 

How now shall we explain the serious and unusual effects of 
so simple and common a disturbing cause as mosquito bites in 
this instance ? Similar manifestations and of as varied a type, 
although of much milder degree, I have often seen in individual 
cases before ; but the fact of six persons of one family simul- 
taneously exhibiting such extraordinary results, shows the ex- 
istence of some unusual element in the case. That element 
I believe to have been a want of protection against the poi- 
son of these insects through prior inoculation. The family, 
leaving their home in England, had arrived in Boston well 
and clean two weeks previous to my seeing them, and had 
spent that interval in lodgings in a street at the North End, 
where there were many mosquitos, insects they had never 
seen before. Although the appearances were confined to parts 
exposed to their bites, they were quite unsuspicious of the 
cause of trouble. 



186 DERMATITIS VENENATA. 

Here was then a new virus inserted through hundreds of 
points into tissues and fluids never before impressed by its 
presence ; unprotected, as I assume, by this mysterious influ- 
ence of past contact or mixture. I am justified in my con- 
clusion moreover, I think, from observation in many other 
instances. The worst cases of mosquito bites that I have been 
called upon to treat, serious enough to require medical advice 
I mean, have been in foreigners newly arrived in Boston from 
Europe, or in persons from other parts of the country, where 
our city mosquito of late summer and fall is not found. 

I find an interesting confirmation of this view in Froude's 
" Oceana." He writes thus of his first night spent in Sydney, 
Australia: "I awoke in the morning bitten over hands and 
face. Where the mosquito has fastened his fangs and poured 
in his poison, there rise lumps and blotches which irritate to 
madness. The blotch opens into a sore, and I was left with a 
wound on the back of my right hand, which did not heal for 
a month. Happily he chiefly torments the new-comers. I 
was inoculated that night, and suffered no more afterwards. 
Perhaps the blood is in some way so affected that the venom 
finds an antidote." 

From my own experience, I can testify as to the protec- 
tion which acquaintance affords against the bites of the other 
two insects named. I was never bitten by a bedbug until I 
left my home for life at Cambridge. For some time their 
attacks upon me there were productive of large swellings, in 
appearance like those of erythema nodosum, and in parts of 
loose texture, as the eyelids, of considerable oedema, not unlike 
erysipelas of those parts. Gradually, as I got used to them, as 
we say, an expression highly suggestive in this connection, the 
effects were less and less severe, and since that time the ex- 
tended acquaintance with them which travel and our system 
of frequent change of servants in domestic life makes unavoid- 
able, has reduced the severity of their action upon me to a 
mild urticarial lesion of a few hours' duration. This personal 
experience I know to be that of several of my friends, with 
whom I have spoken on the subject. Classes of persons, on 



DERMATITIS VENENATA. 187 

the other hand, who are brought up with them as bed com- 
panions, and whose homes swarm with them, will almost 
always say that they do not mind them much, or are uncon- 
scious of their presence, although their young children present 
at first all the characteristic appearances of being severely bit- 
ten. Yet they prey upon old and young alike. 

With fleas, too, my experience warrants a similar conclusion. 
This insect is by no means so abundant in New England as in 
warmer regions of our own country, or in the districts of the 
Old World most frequented by travellers. The majority of the 
residents of our New England villages and towns very probably 
have never seen or been bitten by a flea, except possibly by 
those of the dog or cat. To such the plague of fleas met with 
when they travel abroad is perhaps the most acute and long- 
est remembered impression of their foreign trip. It by far 
outbalances the exemption from the annoyance of the bugs 
and mosquitos incident to their home travel 

My first nights in the Vienna Gebarhaus under those long- 
wooled blankets, so well adapted to flea-breeding, were hours 
of torment, and after each of them my body for the next 
thirty-six hours was the thickly covered seat of an urticarial 
efflorescence of a phoenix-like type. But after a month or two 
I got used to the fleas, so that their bites were borne with some 
degree of equanimity, and the irritation caused was confined 
more strictly to the immediate proximity of the point of in- 
sertion, and with no tendency to recur after the shortened 
primary sensation had passed. Those, on the other hand, 
brought up in daily contact with them, generally pay little 
heed to their attacks ; and the terms custom and use applied 
in explanation of this latter fact, when we think to interpret 
them, are but the unconscious recognition of the operation of 
the law in question. 

These data may seem insufficient to establish a theory, not, 
so far as I know, generally adopted hitherto ; but I mainly cite 
my own case alone, because it has afforded me the best oppor- 
tunity for close and long-continued observation, while it is fully 
sustained by my general experience in special practice. 



188 DERMATITIS VENENATA. 

The application of this law to the insects above named as- 
sumes, of course, the power on their part to irritate the skin 
in some way other than mechanically ; and although a study 
of their anatomy fails to reveal anything to explain the nature 
of this function, arid they are not recognized as secreting a poi- 
son, the peculiar effects of their bites can be accounted for in 
no other way. It is a property no doubt conferred upon them 
for the purpose of stimulating the circulation of the part in- 
jured, and of thus bringing to them a freer flow of their desired 
food, which the skin resents. The prurigo-like papule, the 
purpuric macule, the livid and lichenoid efflorescence, the 
wheal and the (edematous nodule, which give an unmistakable 
individuality to the bite of the louse, flea, mosquito, and bed- 
bug respectively, cannot possibly be reproduced, or in any way 
imitated, by the puncture or laceration of the cutaneous tissues 
with a clean metallic instrument. They are the result of con- 
tact with some peculiar and distinct virus or irritating sub- 
stance in each case, and are to be considered in this connection 
quite apart from the secondary and general lesions which follow 
upon and are caused by the subsequent scratching they excite. 

If there be sufficient evidence in what I have adduced to 
show the possibility of adding this as another instance to the 
list of illustrations first mentioned of the mysterious law 
of protection by inoculation, it will strengthen still more the 
conviction that an ever-increasing number of foreign elements 
is engrafted upon man's normal essence as he progresses in 
life, which are more or less lasting and transmissible in their 
effects, and which essentially modify his primitive nature. 



Hydrozoa. Medusae. Polyps. 

Among these low forms of marine life there are 
many which have the power of irritating the skin, 
and hence are called urticce marince, orties de mer, 
Seenesseln, etc. Most of them possess special cells 
or bladders, which contain stinging filaments coiled 



DERMATITIS VENENATA. 189 

within them, ready to be uncoiled or darted against 
anything which presses upon them, and to discharge an 
irritating fluid. Many of the jelly-fishes, which abound 
in our waters, possess this property, and frequently 
cause an intense prickling and redness of the skin 
among swimmers. The water in which they live may 
derive from them similar irritative properties. Much 
more powerful effects are produced by some of the 
tropical forms. 

Mr. Bennett thus describes the action of Physalia 
utriculus, the Portuguese man-of-war : " On one oc- 
casion I tried the experiment of its stinging pow- 
ers upon myself intentionally. When I seized it by 
the bladder portion, it raised the long cables, and, 
entwining the slender appendages about my hand 
and finger, inflicted severe and peculiarly pungent 
pain. The stinging continued during the whole time 
that the minutest portion of the tentacula remained 
adherent to the skin. . . . The secondary effects 
were very severe, continuing for nearly three quarters 
of an hour; the duration being probably longer in 
consequence of the delay occasioned by removing the 
tentacula from the skin, to which they adhered by the 
aid of the stinging capsules. On the whole being re- 
moved, the pain began to abate ; but during the day a 
peculiar numbness was felt, accompanied by an in- 
creased temperature in the limb on which the sting 
had been inflicted. For some hours afterwards the 
skin displayed white elevations, or wheals, on the 
parts stung, similar to those resulting from the poi- 
son of the stinging-nettle. After the creature has 
been removed from the water for some time, the sting- 
ing property, although still continuing to act, is found 



190 DERMATITIS VENENATA. 

to have perceptibly diminished. I have observed, also, 
that this irritative power is retained for some weeks 
after the death of the animal in the vesicles of the 
cable, and even linen cloth which has been used for 
wiping off the adhering tentacles, when touched, still 
retained the pungency, although it had not the power 
of producing such violent constitutional irritation." * 

Mr. A. Agassiz, of the Museum of Comparative Zool- 
ogy, whose practical experience with marine life is so 
extensive, kindly sends me the following information. 

Museum op Comparative Zoology, 
Cambridge, Mass., Nov. 26, 1886. 

There are among the Fishes a number of species which are 
dangerous from wounds inflicted by sharp spines of dorsals 
and pectorals, or anals. 

Among Annelids there are many species the sharp bristles of 
which produce great pain, accompanied by numbness. They 
belong mainly to the family of Amphinomidse and Eunicidse. 

Among the Polyps and Sea-anemones, many of the larger 
tropical and deep-water species produce a stinging effect, like 
nettles, from action of their large lasso cells. Many species 
of Corals do the same, — in a less degree, however. 

But it is among the Jelly-fishes that the most dangerous 
animals are found. The large red Cyanea of our coast will, if 
it surrounds an arm or leg or body, irritate to such an extent, 
combined with producing numbness, as to become quite dan- 
gerous. Many of the Jelly-fishes with large tentacles have to 
be handled with the greatest care on this account. Action 
produced by lasso cells similar to those of the Polyps. In the 
Portuguese man-of-war (Physalia) the lasso cells are very 
powerful, and the sting produced is most painful. There are 
others among the Siphonophores which are also dangerous. 
The Hydroids of some of the Jelly-fishes also produce a gentle 
irritation from a similar cause. 

1 Wright's "Animal Life." 



DERMATITIS VENENATA. 191 

Among the Sea-urchins, those with short, sharp, delicate 
needle-like spines — Diadema, Echinothurise, Spatangoids — 
produce when handled a similar sensation to that produced by- 
Jelly-fishes. In some cases the spines have a poisonous 
gland (?), a bag attached to the shaft, which may serve to 
irritate the wound. If you want this in greater detail, I 
could give you some more names ; but it would take me 
quite a while to hunt them up. The above are the general 
groups in which such action has been noticed. 

Yours truly, 

Alexander Agassiz. 



Hirudo medicinalis. Leech. 

In addition to the peculiar wound or bite made by 
the mouth of the worm, instances are on record in 
which more or less severe erysipelatous inflammation 
of the surrounding skin, and long and persistent sup- 
puration, even circumscribed gangrene, have followed 
the application of leeches. 

Acanthia lectularia. Bedbug. 

Pulex irritans. Common Flea. 

Culex pipiens. Mosquito. 

These three insects, which draw their sustenance in 
part from human blood by puncturing the skin, pro- 
duce an inflammation characterized by one common 
form of lesion, the wheal. Variations from this typi- 
cal efflorescence occur, as the mildest and most fugitive 
exhibitions of erythema immediately surrounding the 
point of puncture, or a minute red papule ; or, on the 
other hand, large areas of oedema, as in giant urticaria, 
causing great disfigurement lasting for a day or two 
at times. In some persons no impression whatever 
seems to be produced upon the cutaneous tissues by 



192 DERMATITIS VENENATA. 

the " bite/' not even the usual subjective symptoms of 
itching. Occasionally, as in true urticaria, the wheal 
will subside after a few minutes or hours, to revive 
with its primary intensity after half a day or longer, 
and this intermittent activity may continue for two or 
three days. Occasionally the wheal may give place to 
a small papule of several days' duration, and in excep- 
tional cases to troublesome excoriations. In persons 
whose tissues are of feeble vitality, especially chil- 
dren, or saturated with alcohol, still worse lesions 
may result, — pustules, ecthymatous forms of eruption, 
or ulcerations, which are slow to heal. Hemorrhagic 
extravasations about the puncture, especially those of 
the flea, occasionally occur, and pigment stains not 
unfrequently mark the seat of all these forms for an 
indefinite time. Still more exceptional and exagger- 
ated -inflammatory lesions may be produced upon the 
skins of those who are bitten for the first time, as was 
described above. But are there any distinguishing 
marks by which the bite of any one of these insects 
may be recognized? The mosquito generally stings 
those portions of the skin which are uncovered by 
clothing, as the hands and face, but the lower legs of 
children are often protected only by stockings which 
are easily penetrated by the " bill," and in the night 
the bed-clothes are often thrown wholly off, so that 
the whole surface may exhibit the "bites." The 
lesions are often much more numerous than those pro- 
duced by the flea or bedbug, owing to the great num- 
bers which often attack the person at one time. The 
poison, moreover, seems to be less virulent in char- 
acter than that inserted by the last two insects, as 
the lesions are generally smaller and shorter-lived. 



DERMATITIS VENENATA. 193 

The bite of the flea generally exhibits in the centre of 
the wheal a slight pit or dark point, which marks the 
puncture. The efflorescence is often grouped closely, 
so as to form at times elevated areas of considerable 
extent, and the itching is generally more intense than 
with either of the others, and more persistent. It is 
more disposed also to present hemorrhagic effusions. 
The bedbug is as insatiate in its ravages as the flea, 
and often makes an incredible number of bites within 
a small area. It may attack during the night parts 
ordinarily unprotected by clothing, as the hands and 
face. The injuries they all inflict upon the skin are 
generally confined to the direct lesions, and are rarely 
accompanied or followed by the secondary forms of 
eruption which form so important a part of pediculous 
disease and scabies. 

There are numerous other flying insects, other 
species of mosquito, midges, gnats, etc., capable of 
producing inflammation of the skin, erythematous 
macules, papules, or wheals, not differing materially 
from the lesions above described, which require no 
more special mention here. 

Pulex penetrans. Chigoe, or Jigger. 

The female sand-flea burrows into the skin, gen- 
erally of the toes, and produces after a few days a 
painful oedema with redness, and, later, pustulation. 
Frequently ulceration and abscess formation result 
from its presence, or improper attempts at removal. 
The opening into the skin made by the insect should 
be dilated by a needle, and the distended animal 
extracted with the same. 

13 



194 DERMATITIS VENENATA. 

Simulmm. Blackfly. 

This pest of the woods, which so sadly interferes 
with the pleasures of the hunter and angler, produces 
with most of its victims a puncture in the skin from 
which the blood flows freely for a time. I have seen 
the eyes almost stopped with the coagulation of blood 
flowing into them from innumerable bites upon the 
forehead. Occasionally the bites cause great swelling, 
especially upon the scalp, and furuncular forms of 
inflammation with much suffering. 

Leptus. Harvest Mite. 

Two species of this mite, Americanus and irritans, 
are found in this country, resembling the autumnalis 
of Europe. They all cause great irritation of the skin 
by their bites, characterized by papules, vesicles, and 
pustules. They bury their anterior portion only within 
the skin. 

Sarcoptes hominis. Itch Insect. 

The inflammatory lesions produced by the presence 
of this animal in the cutaneous tissues are of two 
kinds, those directly due to the action of the insect, 
and those which result secondarily from the itching it 
causes. The first consist of small papules, vesicles, 
and pustules immediately provoked by the young and 
males, and the long burrow containing the female and 
eggs, which is often surrounded by a red halo, or is 
pushed up above the general level by an inflammatory 
exudation beneath it, or converted into a pustule. 
The secondary lesions are of an eczematous character, 
and result both from the severe scratching the skin 
receives and from the irritating presence of the ani- 



DERMATITIS VENENATA. 195 

mal. They are not confined to the near vicinity of 
the primary lesions, but may be developed over the 
whole surface of the body excepting the head. They 
consist of papules, vesicles, pustules, excoriations, and 
crusts, and sometimes of large ecthymatous forms of 
efflorescence. 

Pediculus capitis. Head Louse. 

This louse may exist in great numbers upon the 
hairs without producing any inflammation upon some 
persons, but generally it excites by its puncture upon 
the scalp much irritation, which leads to scratching, 
and this in turn to various forms of efflorescence, not 
only upon the scalp, but upon those portions of the 
skin bordering upon it. They are eczematous in 
character, and consist of papules, vesicles, pustules, 
and excoriations. The hair is often matted by the 
coagulation of the serum oozing from large areas 
of excoriation. The eczema often extends to a con- 
siderable distance below the occiput, affects the ears 
or forehead, but sometimes manifests itself exclu- 
sively about the nostrils and mouth, when the scalp 
and its immediate surroundings show no signs of 
inflammation. 

Pediculus vestimenti. Clothes or Body Louse, 

This louse, although breeding upon the clothing, 
draws its nourishment from the fluids of the skin by 
puncture. It gives rise to papules primarily, but ex- 
cites so much irritation of the integument that it is 
scratched more violently in most cases than in any 
other itching affection, in consequence of which deep 
and extensive excoriations are formed by the nails, 



196 DERMATITIS VENENATA. 

and later all grades of inflammatory lesions are 
secondarily developed, papules, pustules, crusts, and 
shallow ulcerations. In cases of life-long standing, 
so frequently seen in foreign hospitals, the so-called 
vagabond's disease, the general surface may gradu- 
ally assume a very dark color, in consequence of the 
deposition of blood pigmentation resulting from pro- 
longed and continuous hyperemia. 

Phthirius pubis. Pubic Louse, 

The injuries inflicted by this louse are confined to 
those regions of the skin which are covered by the 
short hairs, the genitals and their surroundings more 
especially, but also in hairy persons the legs, trunk, and 
arms ; also the axillae, and occasionally the eyebrows 
and eyelashes. They consist of minute red macules 
and papules at the base of the hairs. They rarely give 
rise to more serious lesions directly, but sometimes ex- 
cite secondarily an eczema about the genitals, of any 
possible intensity and duration. 

Apis, Bcgnbus, Vespa. Bees, Hornets, Wasps. 

Many species of these hymenopterous insects possess 
stings and poison glands at their posterior extremity, 
capable of producing inflammation when inserted into 
the cutaneous tissues. A lancinating and burning 
pain in the part stung is first felt, which is generally 
followed by an erythematous swelling, resembling a 
boil, and presenting a darker point in its centre. The 
swelling may extend and assume an erysipelatous 
character with radiating red streaks. Gangrene of the 
affected area has rarely been observed. 



DERMATITIS VENENATA. 197 

Cantharis. Spanish Fly, 

Powdered cantharides, or their irritating principle, 
cantharidin, applied to the skin, very soon produce a 
burning sensation and redness, which rapidly increase 
to intense smarting and a most violent superficial 
dermatitis. The process is so rapid in its evolution, 
that the ordinary transition steps of acute cutaneous 
inflammation are not observed, and in a very brief 
period, three to five hours, hyperemia of the upper 
corium, escape of serum into the epidermal layers in 
great quantity, with elevation of the same in the shape 
of vesicles and bullae, large and small, take place. 
Unless the irritant be kept too long in contact with 
the skin, the excitement of the tissues slowly subsides 
from this point, under soothing dressings, with the 
ordinary changes of involution of an acute dermatitis. 
Sometimes, however, instead of the clear and abundant 
discharge of serum from the inflamed corium, there is 
formed a pseudo-membranous layer of fibrinous nature 
beneath the bullae ; or in feeble persons, infants, and 
old people, gangrene of the inflamed tissues may result. 
Sometimes an erysipelas spreads from the blistered 
surface, or an eczema may affect the surrounding in- 
tegument and in children extend over the whole body. 
Furuncular and ecthymatous eruptions may also be 
excited in the vicinity of the vesicated area. Symp- 
toms of internal poisoning may manifest themselves, 
as is well known, by absorption. In place of these 
extreme grades of dermatitis, all degrees of reduced 
irritation of the skin may be produced at will by dilu- 
tion of the active agent down to the mildest rubefacient 
result, or the stimulation of the cutaneous glands 



198 DERMATITIS VENENATA. 

without the slightest visible hyperaemia or sensation of 
heat. 

Other insects possess this irritating action upon the 
skin in the same or less degree, as Blatta, Formica, etc. 

Formica. Ants. 

This and several other genera of ants, especially 
those of tropical countries, produce by their " bites " 
a vivid sensation of stinging (formic acid ?), resem- 
bling that caused by the nettle, with a slight ery- 
thematous oedema in the skin. Tropical forms may 
cause great pain, with the formation of vesicles, and 
even serious constitutional disturbances. 

Bombyx, G-astropacha. Caterpillars. 

The hairs of the caterpillars of these and many other 
genera of the Lepidoptera, with the dust of their bodies 
and the fluids which they discharge from their anterior 
or posterior openings and other parts, produce by me- 
chanical or chemical action great irritation upon the 
skin of those who handle them. The first symptoms 
are intense itching, with pain, redness, and swelling. 
Later an erysipelas-like erythema and urticarial ef- 
florescences may develop, or papules, vesicles, and 
pustules may be formed. Occasionally phlegmon, ab- 
scesses, and inflammation of the lymphatics have been 
observed. 

Van Hasselt gives the following list of injurious 
larvae belonging to European families : Gastropacha 
pityocampa, Gastropacha pini, Gastropacha proces- 
sionea, Bombyx mori, Harpya vinula, Sphinx Eu- 
phorbias ; and the following as suspicious : Liparis 
auriflua, Liparis chrysorrhcea, Liparis dispar, Gas- 



DERMATITIS VENENATA. 199 

tvopacha pinivora, Phalcena potatoria, and Plusia 
gamma. 

Riley, in his Fifth Annual Report on Noxious and 
other Insects of Missouri, gives the following list of 
larvae in the West, the spines of which have urticating 
properties : Lagoa crispata, Lagoa opercidaria, Euclea 
pcenulata, Euclea querciti, Parasa chloris, Phdbetron 
pithecium, Phdbetron hyalinum, Adoneta spinuloides, 
Monoleuca semifascia, Empretia stimulea, Acronycta 
xylinoides, Anisota stigma, Pseudohazis Eglanterina. 
He attributes their irritating action upon the skin to 
the prick of the spines, and states that the dried larvae 
in collections retain this power for a long time. 

Mr. George Dimmock of Cambridge describes very 
fully in " Psyche," Nos. 102 and 103, the tegumentary 
glands of many larvae communicating with hollow 
hairs, and containing a fluid to which he attributes 
such irritating properties. 

Mr. Scudder adds to the above lists Hypercheria, 
Io, and a species of Lagoa. He writes : " I recall an 
instance where a friend let one of these last silken, 
snow-white caterpillars crawl over his hand and up 
his arm above the elbow, and it was not for some time, 
five or ten minutes, that he began to suffer in conse- 
quence. Then the track of the larva was marked by 
a red flush over the whole arm, and my recollection is 
that he suffered a good deal." 

Silk Cocoons. 

Dr. Potton of Lyon has described (Bull, de l'Acad. 
de Med., xvii. 803), under the title Mai de vers, an 
inflammatory affection of the hands among silk weav- 
ers who unwind the silk from the cocoons. It begins 



200 DERMATITIS VENENATA. 

after a week of constant work. The right hand is 
especially affected. A redness and swelling develop 
at the base of and between the fingers, accompanied 
by itching, which is followed by rounded vesicles, 
which, if the disease progresses, are converted into 
pustules, which may spread rapidly over the whole 
surface of the hand. The eruption is accompanied at 
first by itching, and later by acute pain, so as to ren- 
der motion of the part impossible. The process is at 
its height on the fifteenth or sixteenth day, and the 
vesico-pustules may leave, on breaking, swollen and 
ulcerated surfaces. After this stage recovery rapidly 
follows, so that by the eighteenth day the patient is 
able to go to work again. Occasionally the disease 
assumes a more serious form. The inflammation 
affects the skin, even to the subcutaneous tissues ; the 
swelling is enormous, and the course of the lymphat- 
ics is marked by red lines extending to the axillary 
glands. Small circumscribed seats of phlegmonous 
inflammation are developed beneath the pustules. 
Nevertheless, in spite of all these menacing symp- 
toms, the inflammation rapidly subsides, and by the 
twentieth day the cure is complete. Recurrences of 
the affection are generally much less severe than the 
primary attack. M. Potton attributes the disease to 
the presence of the worm in the cocoon, to its decom- 
position, and to changes which gradually take place in 

its interior. 1 

Mr. F. W. Cheney, of the celebrated silk works 
of South Manchester, Conn., very kindly informs me 
that in their extensive factory no cases of inflamma- 
tion of the skin have occurred among their workmen. 

1 See Bazin, Affections Cutanees Artificielles. 



DERMATITIS VENENATA. 201 

Buthus. Scorpion. 

The local effects of the sting of the scorpion, of 
which there are many species, are an erythematous 
oedema with a dark point in the centre, and excessive 
pain. Some species produce effects closely resembling 
those of a wasp-sting, but others, which are powerful 
enough to cause fatal results, give rise to black dis- 
coloration, with great swelling of the part, inflamma- 
tion of the lymphatics, and even gangrene. 

Spiders. 

The bite of many species of spider, which are pro- 
vided with a poison apparatus, produces a redness and 
swelling, with more or less pain and itching. Some- 
times phlegmonous inflammation results. 

Ixodes. WoodticJc. 

Several species of these ticks infest our woods and 
attach themselves to the skin by their compound beaks, 
which they bury in its tissues. They produce much 
irritation, and if the head be allowed to remain in the 
skin, when the animal, swollen with the blood drawn, 
is perceived and removed, great inflammation of the 
tissues follows, accompanied by persistent suppuration 
until the foreign body is extracted. 

Treatment. 

The treatment of the direct injuries inflicted upon 
the skin of man by the bites and stings of these vari- 
ous animals, and the resulting forms of dermatitis, is 
very simple. Ordinarily, they are of brief duration, 
unless they are constantly reproduced by the continuous 
presence of the animal. The first object is, therefore, 



202 DERMATITIS VENENATA. 

to remove the latter from the surface, or from within 
the tissues of the skin ; the second, to allay the irrita- 
tion produced at the point of injury ; and the third, to 
subdue the inflammation which results, either directly 
or secondarily, from this. 

Pediculi may be removed from the hairs of the head 
and body by soaking the same in petroleum, and allow- 
ing them to remain saturated for an hour or so for 
several days in succession. From the clothing (P. 
vestimenti) they are removed by boiling all under-gar- 
ments in water, and ironing the seams of the outer ones 
with a very hot flat-iron. 

The itch insect is destroyed by rubbing into the skin 
preparations of sulphur, naphthol, Peruvian balsam, 
etc., for several days in succession. 

The chigoe is extracted by carefully dilating the 
aperture of entrance with a needle, and removing 
with the same. 

The ixodes is made to relax its hold and drop off by 
applying sweet oil repeatedly to it. 

The leptus mite may be treated as the itch insect by 
similar parasiticides. 

With the removal of these animals the inflammation 
which they have excited in the skin generally subsides, 
more or less gradually, without special treatment. 

Bites and stings, and the irritation produced in other 
ways by contact with the other animals above men- 
tioned, may be immediately treated by ammonia water, 
dilute acetic acid or vinegar, dilute carbolic acid, al- 
cohol, a drop of laudanum, etc., and generally with 
some relief. 

The more diffused and the secondary forms of in- 
flammation which often follow may be controlled by 



DERMATITIS VENENATA. 203 

the means best adapted to the management of similar 
grades of dermatitis in other cases. Cooling and as- 
tringent washes and soothing ointments are mostly 
called for in the secondary lesions ; whilst evaporating 
lotions of spirit and water, to which carbolic acid has 
been added, will be found most effective upon the 
early inflammation immediately surrounding the point 
of injury. 



BIBLIOGRAPHICAL REFERENCES. 



Bazin. Leqons thdoriques et cliniques sur les Affections 

cutane*es. Paris. 1862. 
Bigelow. American Medical Botany. Boston. 1817. 

" Florula Bostoniensis. Boston. 1824 

Dispensatory, The National. Stille and Maisch. Phila- 
delphia. 1884 
Chapman. Flora of the Southern United States. New York. 

1883. 
Gray. Manual of the Botany of the Northern United States. 

New York. 1870. 
Loudon. Encyclopaedia of Plants. London. 1855. 
Oesterlen. Handbuch der Heilmittellehre. Tubingen. 1856. 
Piffard. A Treatise on the Materia Medica and Therapeutics 

of the Skin. New York. 1881. 
Van Hasselt. Handbuch der Giftlehre. Braunschweig. 1862. 
Wood. Flora of the United States and Canada. New York. 

1873. 



INDEX. 



INDEX. 



Abies Canadensis 

excelsa . . 
Acanthia lectularia 
Acid, Carbazotic 
Carbolic 
Chromic 
Formic . . 
Hydrochloric 
Muriatic 
Nitric . . 
Picric . . 
Pyrogallic . 
Salycilic 
Sulphuric . 
Sulphurous 
Toxicodendric 
Acne from tar . . 
Aconitum napellus 
Acronycta xylinoides 
Actsea spicata . . 
Adoneta spinuloides 
Ailanthus glandulosa 
Alisma .... 
Alismacese . . . 
Allium sativum 
Allspice .... 
Ammonia. . . . 
Ammonia, carbonate 
Amphionomidse . . 
Anacardiacese . . 
Anacyclus pyre thrum 
Andira Araroba 
/Andromeda arborea 



PAGE 

89 

89 

191 

154 

148 

172 

154 

156 

156 

156 

154 

152 

152 

155 

155 

55 

148 

117 

199 

118 

199 

125 

31 

31 

102 

111 

156 

157 

190 

31 

78 

100 

93 



PAGE 

Andromeda tree .... 93 

Anemone nemorosa . . . 118 

patens 118 

pratensis 118 

Anemone, Sea 190 

Anemonin 119 

Angelica tree 74 

Animal Irritants .... 179 

Anisota stigma 199 

Annelids 190 

Antiaris toxicaria .... 74 

Antimony 171 

Antimon. et Potas. Tart. . 171 

Ants 198 

Apis 196 

Apocynaceae 72 

Aqua ammoniae .... 156 

chlori 162 

Aracese 73 

Aralia spinosa 74 

Araliaceae 74 

Arbor Vitaa 90 

Argenti nitras 171 

Arissema dracontium ... 74 

triphyllum 73 

Arnica montana .... 79 

Arrow poison 75 

Arsenic 162 

Arsenicum 162 

Artocarpaceae 74 

Asparagus officinalis . . . 102 

Atherix maculatus ... 86 

Aurantiaceas 75 



14 



210 



INDEX. 



PAGE 

Balm of Gilead . . . 127 

Baneberry ...... 118 

Bartonia, Golden .... 110 

Bayberry Ill 

Bay Rum 112 

Bedbug 191 

Bees 196 

Beggar's-weed 119 

Beggar-ticks 87 

Berberidacese 76 

Bibliographical references . 205 

Bidens frondosa .... 87 

Bignoniacese 77 

Bitter Orange 75 

Blackfly 194 

Black Hellebore .... 120 

Blatta 198 

Bloodroot 115 

Blue Cohosh 116 

Bombus 196 

Bombyx mori . . . . . 198 

Borage 78 

Borago officinalis .... 78 

Borraginaceae 78 

Box 93 

Brine 158 

Bromine 161 

Bromum 161 

Bryonia alba 92 

Burdock 87 

Burgundy Pitch .... 89 

Burr-marigold 87 

Buthus 201 

Buttercups 120 

Buxus sempervirens ... 93 

CactacevE ...... 78 

Cactus grandiflorus ... 78 

Cade, Oil of 147 

Calcium pentasulphide . . 159 

Calx 158 

Canada Pitch 89 

Cantharidin 197 

Cantharis 197 

Capsaicin 131 

Capsicum annuum .... 131 



PAGE 

Capsicum fastigiatum . . 131 

frutescens 131 

longum 131 

Carbazotic Acid .... 154 

Carbolic Acid 148 

Carbonate of Ammonia . . 157 

of Potash 157 

Cardol 71 

Cashew Nut 71 

Catalpa 77 

Caterpillars 198 

Caulophyllum thalictroides . 116 

Cedar, Red 90 

Celandine 115 

Cephaelis ipecacuanha . . 122 

Cereus, Night-blooming . . 78 

Chelidonium majus . . . 115 

Chigoe 193 

Chimaphila umbellata . . 93 

Chloral 154 

Chloral Hydrate .... 154 

Chlori aqua 162 

Chloride of Platinum , . . 175 

of Sodium 158 

Chlorinated Lime .... 162 

Chlorinated Soda . . . . 162 

Chlorine 162 

Chloroform 155 

Chloroformum 155 

Chlorum 162 

Christmas Rose .... 120 

Chromic Acid 172 

Chromium compounds . . 173 

Chrysarobinum 100 

Cinchona 123 

Citrine Ointment .... 170 

Citrus vulgaris 75 

Clematis erecta ..... 119 

Virginiana 119 

Clotbur 89 

Clothing, Poisonous . . . 175 

Cnidoscolus stimulosus . . 97 

Cocklebur 89 

Cocoons 199 

Cohosh, Blue 116 

Colchicum autumnale . . 110 

Composite 78 



INDEX. 



211 



PAGE 

Coniferae 89 

Corals 190 

Corchorus olitorius . . . 109 

Corrosive Sublimate . . . 170 

Cowhage 101 

Cow Parsnip 136 

Crassulaceae 90 

Creasote 148 

Creasotum 148 

CrotonOil 194 

Crotum Tiglium .... 94 

Cruciferae 91 

Cucurbitaceae 92 

Culex pipiens 191 

Cyanea 190 

Cypripedium parviflorum . 113 

pubescens 113 



Daphne gnidium . . 

laureola .... 

mezereum . . , 
Datura stramonium , 
Delphinium consolida 

staphisagria . . 
Dermatitis, 

anatomical changes in 

bullae in 



causes . . 
cicatrix in . 
constitutional 
ances . . 



course . . 
crusts in 
diagnosis . 
ecthymatous 
effects . . 
erythematous 
excoriations in 
furuncular 
maculae in 
papulae in 
prognosis 
pustules in 
scales in 
seat of . 
subjective symptoms 



disturb 



132 
132 
132 
132 
119 
119 

10 

13 

9 

15 

16 
16 
15 
17 
14 
10 
10 
14 
14 
10 
12 
18 
13 
14 
16 
16 



PAGE 

Dermatitis, treatment . . 18 

ulcers in 15 

vesicles in 13 

wheals in 11 

Diadema 191 

Dirca palustris 133 

Dolichos 102 

Dragon-root 73 

Drosera rotundifolia ... 92 

Droseraceae 92 



ECHINOTHURIiE 

Electricity . . 
Elkwood . . . 
Emetine . . . 
Empretia stimulea 
English Moss 
Ericaceae . . . 
Erigeron Canadense 
Euclea paenulata 

querciti . . 
Eugenia pimenta 
Eunicidae . . 
Euphorbia corollata 

ipecacuanhas 

lathyris . . 

resinifera . 
Euphorbiaceae . 

Ferula galbaniflua 
Flax .... 
Flea .... 
Fleabane . . . 
Formica . . . 
Formic Acid . . 
Fungi .... 



Galbanum . . . 

Garden Nasturtium 
Garden Rue . . . 

Garget 

Garlic 

Gastropacha pini . 

pinivora . . . 

pityocampa 



191 

177 

93 

122 

199 

90 

93 

87 

199 

199 

111 

190 

96 

96 

96 

95 

93 



136 
104 
191 

87 
198 
153 

98 



136 
133 
126 
116 

102 
198 
199 
198 



212 



INDEX. 



PAGE 

Gastropacha processionea . 198 

Gelseinium sempervirens . 110 

Gnats . . ... . . . 193 

Goa Powder 100 

Golden Bartonia . . . . 110 

Golden-rod 89 

Green Dragon 74 



Harpya vinula . . . 


198 


Harvest Mite .... 


194 


Hedge Mustard . . . 


91 


Helleborus niger . . . 


120 


Hemlock Spruce . . . 


89 


Heracleum lanatum . . 


136 


Hesperidene 


76 


Hippomane mancinella . . 


96 


Hirudo medicinalis . . 


191 


Hornet . . . . . . . . 


196 


Horseradish 


91 


Horseweed 


87 


Houseleek 


90 


Hura Brasiliensis . . . 


97 


crepitans .... 


97 


Hydrargyrum .... 


169 


Hydrate of Chloral . . 


154 


Hydrochloric Acid . . . 


. 156 


Hydrozoa 


. 188 


Hypercheria 


199 



Indian Bean 77 

Marking-nut .... 71 

Tobacco 110 

Turnip 73 

Inorganic Irritants . . . 145 

Insect Powders 79 

Io 199 

Iod-glycerine 160 

Iodine . 160 

Iodoform 161 

Iodoformum 161 

Ipecac 122 

Iridaceae 100 

Iris Florentina ..... 100 

versicolor 100 

Irritants, Animal .... 179 

Inorganic 145 



page 

Irritants, Organic .... 145 

Vegetable 25 

Itch Insect 194 

Ixodes 201 

Jaborandi 125 

Jack-in-the-Pulpit .... 73 

Jamestown-weed .... 132 

Jatropha stimulosa ... 97 

urens 97 

Jelly-fish 189 

Jessamine, Yellow .... 110 

Jigger 193 

Juniperus communis ... 90 

oxycedrus 147 

Sabina 90 

Virginiana 90 

Jute 109 

Lacquer Poisoning . . 53 

Lagoa crispata 199 

opercularia .... 199 

Laportea Canadensis . . . 137 

Lappa officinalis .... 87 

Larkspur 119 

Leatherwood 133 

Leech ........ 191 

Leguminosse 100 

Lepidium sativum ... 91 

Lepidoptera 198 

Leptus Americanus . . . 194 

autumnalis 194 

irritans 194 

Leucanthemum vulgare . . 88 

Liliacese 102 

Lime 158 

Linacese 104 

Linum usitatissimum . . . 104 

Liparis auriflua 198 

chrysorrhcea .... 198 

dispar 198 

Loasacese 109 

Lobeliacese 110 

Lobelia inflata 110 

Loganiacese 110 



INDEX. 



213 



Louse, body . 

clothes . 

head . . 

pubic . . 
Lunar Caustic 



Maiscb, Analysis of Rhus 

Manchineel 

Mandrake 

Marking-nut, Indian . . 
Maruta cotula .... 

Masterwort 

May Apple 

Mayweed 

Meadow Saffron . . . 

Medusae 

Melanthaceae .... 
Mentzelia Floridana . . 

Lindleyi 

oligosperma . . . 

Mercury 

Midge 

Monkshood 

Monoleuca semifascia 

Moosewood 

Mosquito ...... 

Mossy Stonecrop . . . 
Mucuna pruriens . . . 

Mullein 

Muriatic Acid .... 

Mustard 

Myrcia acris 

Myrcia, Oil of ... . 
Myrtaceae 



Nasturtium Armoracia 
Garden .... 

Nerium oleander . . 

Nettles 

Night-blooming Cereus 

Nitrate of Mercury . 
of Silver . . . 

Nitric Acid .... 

Norway Spruce . . 



PAGE 

195 
195 
195 
196 
171 



54 

96 

76 

71 

88 

136 

76 

88 

110 

188 

110 

110 

110 

109 

169 

193 

117 

199 

133 

191 

90 

101 

131 

156 

91 

111 

112 

111 



91 

133 

72 

137 
78 
170 
171 
156 
89 



PAGE 

Oil of Beech 147 

of Birch 147 

of Cade 147 

of Myrcia H2 

Rock 151 

of Turpentine .... 146 

Oleander 72 

Oleum cadinum .... 147 

petraa 151 

terebinthinae .... 146 

tiglii 94 

Orange, Bitter 75 

Orchidaceae 113 

Organic Irritants .... 145 

Ox-eye Daisy 88 

Oxydendrum arboreum . . 93 

Papaverace.e 115 

Pappoose-root 116 

Paraffin .150 

Parasa chloris 199 

Pasque-flower 118 

Paste, Vienna 157 

Pediculus capitis . . . . 195 

vestimenti 195 

Pellitory 78 

Pepper, Black 117 

Red 131 

Water 117 

White 117 

Peppergrass 91 

Petrae, Oleum 151 

Petroleum 151 

Phalaena potatoria .... 199 

Phobetum hyalinum . . . 199 

pithecium 199 

Phthirius pubis 196 

Physalia utriculus .... 189 

Phytolaccaceae 116 

Phytolacca decandra . . . 116 

Picric Acid 154 

Pilocarpus pennatifolius . . 125 

Pimento Ill 

Piperaceae 117 

Piper nigrum 117 

Pipsissewa 93 



214 



INDEX. 



of 



var 



Pix liquida . . 
Plantain, Water 
Plants, Poisonous 

classification 

families . . 

list of . . 

method of action 

motive of action 

nature of . . 

number of . . 
Platini Chloridum . 
Platinum, Chloride 
Plusia gamma . . 
Podophyllum peltatum 
Poison Ash . . 

Dogwood . 

Elder . . 

Ivy . . . 

Mercury 

Oak . . . 

Sumach . . 

Vine . . . 
Poisoning by Japanese 
nish . . 

by Japanese lacquer 
Poisonous Clothing 
Poke .... 
Polygonaceae 
Polygonum acre 

hydropiper . 
Polyps .... 
Populus candicans 
Portuguese Man-of-war 
Potash, Bichromate of 

Carbonate of . . 

Potassa 

Potassii bichromas 
Prickly Ash .... 

Elder .... 
Prince's Pine . . . 
Protection against animal 

irritants . . . 
Pseudohazis Eglanterina 
Pubic Louse .... 
Pulex irritans . . . 

penetrans . . . 
Pulsatilla 



PAGE 

147 
31 
25 
26 
29 
29 
26 
27 
26 
27 
175 
175 
199 
76 
32 
32 
32 
31 
& 
31 
31 
32 

54 

54 

175 

116 

117 

117 

117 

188 

127 

189 

173 

157 

157 

173 

74 

74 

93 

181 
199 
196 
191 
193 
118 



PAGE 

Pyrethrum carneum ... 79 

cinerarisefolium ... 79 

roseum 79 

Pyrogallic Acid 152 

Queen's Root .... 98 

Quicklime 158 

Quinine 124 



Ranunculace^e . 






. 117 


Ranunculus acris . 




. 121 


bulbosus 






. 121 


repens . . 






. 121 


sceleratus . 






. 121 


Red Cedar . . 






. 90 


Pepper . . 






. 131 


Rhus diversiloba 






. 31 


metobium . . 






. 70 


pumila . . . 






70 


radicans . . 






32 


Rhus toxicodendron 




. 31 


action of . . 




35 


action on animals 


. 63 


chemical nature of poison 51 


contagiousness of poison 62 


description of plant . 


33 


diagnosis of effects . 


. 45 


duration of attack . 


47 


emanations from . . 


. 57 


fatal effects of . . 


. 43 


lesions produced by . 


44 


period of incubation 


60 


sequelae of poisoning 


48 


therapeutic use . . . 


58 


treatment of . . . 


64 


Rhus venenata .... 


31 


action of ... . 


35 


action on animals 


. 63 


contagiousness of poisoi 


a. 62 


diagnosis of effects . 


45 


duration of attack . 


45 


emanations from . . 


57 


lesions produced by . 


44 


period of incubation 


. 60 


treatment of poisoning 


64 



INDEX. 



215 



PAGE 

Rhus vernicifera .... 52 

cultivation of ... . 52 
lacquer, preparation from 52 

lacquer, poisoning by . 52 

Rhus vernix 32 

Rock Oil 151 

Rubiacese 122 

Rue, Garden 126 

Ruta graveolens .... 126 

Rutacese 125 

Sacchartjm 145 

Salicacese . 127 

Salicylic Acid 153 

Salt, common 158 

Sand-box 97 

Sanguinaria Canadensis . . 115 

Sapo viridis 157 

Sarcoptes hominis .... 194 

Savin 90 

Scorpion 201 

Scrophulariacese .... 131 

Sea-anemone 190 

Sea Burdock 89 

Sea-urchins 191 

Sedum acre 90 

Semecarpus anacardium . . 71 

Silk Cocoons 199 

Silver, Nitrate 171 

Simulium 194 

Sinalbin 91 

Sinapis alba 91 

nigra 91 

Sinapism 91 

Sisymbrium officinale ... 91 

Skunk Cabbage .... 74 

Smartweed 117 

Soda ........ 158 

Sodii Chloridum .... 158 

Solanaceae 131 

Solidago 89 

odora 89 

Solution, Vlemingkx's . . 160 

Sorrel Tree 93 

Southern Prickly- Ash . . 74 

Spanish Fly 197 



PAGE 

Spatangoids 191 

Sphinx Euphorbiae . . . 198 

Spiders 201 

Spruce 89 

Squill 103 

Staves-acre 119 

Stillingia sylvatica .... 98 

Stonecrop, Mossy .... 90 

Stramonium 132 

Sugar 145 

Sulphide of Calcium . . . 159 

Sulphur 159 

Sulphuric Acid 155 

Sulphurous Acid . . . . 155 

Sundew 92 

Symplocarpus fcetidus . . 74 

Tar 147 

Tar Acne 148 

Tartar Emetic 171 

Tayuya-root 92 

Terebinthinae, Oleum . . 146 

Tetterberry 92 

Tetterwort 115 

Thapsia garganica .... 137 

Thymeleacese 132 

Thuja occidentalis .... 90 

Toxicodendric Acid ... 55 

Tread-softly 98 

Tree of Heaven 125 

Tropseolaceas 133 

Tropaeolum majus .... 133 

Turpentine 146 

TImbellifeRjE 136 

Upas antjar 75 

Upas Tree 74 

Urchins, Sea 191 

Urginia scilla 103 

Urtica chamsedryoides . . 137 

crenulata 141 

dioica 137 

ferox 140 

gracilis 137 

pilulifera 139 



216 



INDEX. 



Urtica purpurascens 
stimulans . 



urens 



urentissima 
Urticacese . . 
Urticse marinaB . 
Urtication . . 
Ustilago hypodites 

maydis . . 

segetum . . 



Vanilla planifolia 
Varnish Poisoning 
Veratria .... 
Veratrum album . 

sabadilla . . 

viride . . . 
Verbascum thapsus 

Vespa 

Virgin's-Bower . . 
Vlemingkx Solution 



PAGE 

137 

140 

137 

140 

137 

188 

139 

98 

99 

99 

113 
54 
111 
111 
111 
111 
131 
196 
118 
159 



PAGE 

Wasp 196 

Water Pepper 117 

Water Plantain 31 

White Precipitate .... 170 

Whiteweed 88 

Wild Chamomile .... 88 

Wild Hops 92 

Wind-flower 118 

Wintergreen 93 

Wood Anemone .... 118 

Wood Nettle 137 

Woodtick 201 



Xanthium strumarium. 



89 



Yellow Jessamine . . . 110 



Zinc, Chloride .... 172 
Zinci Chloridum .... 172 



University Press : John Wilson & Son, Cambridge. 























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